Vice President Mike Pence and Health and Human Services Secretary Tom Price came to Capitol Hill on Tuesday to try to salvage the Republican plan to revise the Affordable Care Act, whose chances of passing the House appear increasingly slim.
There was widespread dissatisfaction with the GOP plan from both House and Senate lawmakers — conservative and moderate — after the Congressional Budget Office estimated that 24 million fewer people would have health insurance a decade from now under the American Health Care Act, House Speaker Paul Ryan’s proposal to significantly change Obamacare.
President Donald Trump and his team tried Tuesday to shore up support for the embattled legislation by deploying top staff to meet directly with skeptics and opponents in Congress.
Trump has enthusiastically backed the House GOP proposal through various statements and tweets, and its failure — or the failure of a similar measure — would likely tarnish his promise to replace the Affordable Care Act with a better system.
Later Tuesday, members of the Senate Steering Committee — a conservative coalition chaired by Sen. Mike Lee, a Utah Republican, who has spoken out against the GOP proposal — will meet with Trump’s team at the White House, White House aides said.
The president also planned to speak about health care with Ryan and House Majority Leader Kevin McCarthy, a California Republican, by phone Tuesday afternoon, the White House schedule stated.
Senate Majority Leader Mitch McConnell, a Kentucky Republican, attempted to play down the severity of the GOP split after a closed-door party lunch attended by Pence, Price and some of the architects of the House bill, including House Ways and Means Committee Chairman Kevin Brady, a Texas Republican.
Following the lunch, McConnell tried to shift the focus from the coverage numbers to more favorable terrain for Republicans: the CBO’s projection that Ryan’s plan would reduce the federal budget deficit over the next decade and produce a 10 percent average decrease in premiums after that.
“Regarding the projection of fewer people purchasing, I think that’s the inevitable result of the government not making you purchase something you may not want,” McConnell said. “And so we are hoping to have a more vibrant market that will attract a greater number of people to actually be able to buy, at an affordable cost, insurance that actually makes sense for them rather than one prescribed by the government.”
Sen. Bob Corker, a Tennessee Republican, was more guarded than usual coming out of the meeting. He declined to discuss specifics but said House leaders and the White House were making a good-faith effort to hear the concerns of Republican senators.
“They really are taking input. So I don’t think they would be over here unless they really do want to take input from folks,” Corker said.
The GOP legislation faces an important test Thursday, when the House Budget Committee will meet to combine pieces passed by separate committees into a single bill and advance it to the House floor. The budget panel cannot make substantive changes to the bill, but it can make nonbinding recommendations before it goes to the floor for a final vote.
Several members of the hardline conservative House Freedom Caucus, which has expressed serious concerns that the measure does not go far enough in repealing Obamacare, are on the Budget Committee and could decline to support the measure there.
Republicans hold an eight-vote advantage over Democrats on the Budget Committee, and if four GOP members oppose it, the bill could stall. Three of the 22 Republicans on the panel are members of the House Freedom Caucus.
Aides to those three members — Reps. Dave Brat (Virginia), Gary Palmer (Alabama) and Mark Sanford (South Carolina) — did not respond to inquiries Tuesday about whether they intended to support the legislation in committee. Two other Budget Committee Republicans, Reps. John Faso (New York) and Bruce Westerman (Arkansas), said Tuesday that they were undecided on their committee votes.
Near the close of the Tuesday Senate lunches, Rep. Mark Meadows, a North Carolina Republican, the head of the Freedom Caucus, was seen walking down a hallway near the room where the lunch was held.
“We’ve got some work to do, still,” said Meadows, adding that he has received “no assurances” from the White House or anyone else about changes to the bill that would attract his support. But he added he was having “good conversations” about “Medicaid, essential health benefits and the mandates, all three of those.”
Among the commitments White House staff members have pledged to support is a series of amendments at the budget panel later this week, according to one senior White House official. But special budget rules established more than four decades ago make that plan impossible to fulfill.
Budget Committee members do not have the authority to offer any substantive or binding amendments to the legislation. The committee’s sole job is to combine the recommendations of previous committees — which have passed the GOP proposal — and send the legislation to the House Rules Committee.
Price, the former House Budget Committee chairman, remarked on the rules when similar legislation came before that committee in 2015.
“It is not within our power under the reconciliation process to make substantive changes to the legislation before us,” Price said in a statement at that time. “Today’s markup may not include any amendments. There will be an opportunity for motions regarding process, after the legislation is addressed.”
The House Republicans’ legislation would keep a few of the ACA’s most popular features, such as forbidding insurers to deny coverage or charge more to people with preexisting medical problems and allowing young adults to stay on their parents’ insurance policies until age 26. On the other hand, it would wipe out central aspects of the 2010 health-care law enacted by a Democratic Congress.
The plan would erase penalties the ACA levies on people who violate the requirement that most Americans carry health coverage and, instead, would have a deterrent: a 30 percent surcharge on premiums that insurers could levy for a year if consumers let their coverage lapse. It would remove the ACA’s subsidies for people who cannot get affordable coverage through a job, replacing them with generally smaller tax credits that would be available to people with somewhat higher incomes and give more help to younger adults than older ones. The tax credits could be used for any plan sold in a state, as long as it didn’t provide coverage for abortion, rather than plans with specified levels of coverage that are sold through insurances marketplaces created under the law.
The GOP legislation also would make profound changes to Medicaid, the public insurance program for lower-income Americans. Within a few years, the plan would begin eliminating an expansion of the program that three-fifths of the states have adopted under the ACA. It would end the traditional system in which each state gets a fixed share of its Medicaid costs, no matter how high. Instead, the government would give states each year a fixed sum per person in the program.
In the Senate, moderate Republicans from states that expanded Medicaid have voiced concerns that the measure does not protect those who obtained coverage through that expansion strongly enough.
They worry that the projected deficit reduction would not be enough of a gain to compensate for the CBO prediction that 24 million fewer people would have health insurance in a decade.
“These kinds of estimates are going to cause revisions in the bill, almost certainly,” Sen. Susan Collins, a Maine Republican, said Tuesday of the CBO report.
“I don’t think that the bill that is being considered now is the bill that ultimately will be the one that we vote on in the Senate.”
Sen. Bill Cassidy, a Louisiana Republican, a physician and strong ACA critic, sounded apprehensive about the CBO report’s implications.
“President Trump said that he wants as many people covered as under Obamacare,” Cassidy said Monday. “He said that health care should be affordable. If there’s 14 million people losing insurance, of course it’s concerning. I try to avoid hyperbole and adjectives, but it’s concerning.”
On the right, conservatives have complained that the bill is not a forceful enough repeal of the Obama administration’s health-care law. Sen. Rand Paul, a Kentucky Republican, along with Lee and Sen.Ted Cruz, a Texas Republican, has been the chief conservative critic of the law,
“There is a solution for House Leaders that conservatives have offered: abandon Obamacare Lite now,” Paul wrote Tuesday on Twitter.
“It is bad law & it can’t pass. If House leaders try do a little less using the same basic framework as the failed Obamacare experiment, then it will fail too.”
Lee also raised concerns in an editorial for the conservative Daily Signal that the House bill contains policy changes that would violate strict Senate rules.
One such worry involves a provision that would forbid the use of insurance tax credits for coverage of health-care providers that offer abortion services. Another is a proposed change that would allow health insurers to charge their oldest customers five times as much as their youngest ones, instead of three times as much, as the ACA now specifies.
Other potential problems are a 30 percent surcharge on premiums that insurers would be allowed to impose for new customers who had let their health coverage lapse.
Sen. Tom Cotton, an Arkansas Republican, again urged House leaders to “pause” and take seriously the CBO’s projections on coverage and premiums.
“They’re right that coverage levels will go down in the coming years under the House bill,” Cotton said of the CBO during an interview with conservative radio host Hugh Hewitt on Tuesday morning.
One of those GOP skeptics, Virginia Rep. Rob Wittman, announced Monday that he would oppose the bill. His stance could represent a new front of House GOP dissent as he represents the sort of mainstream conservative that Ryan is counting on to pass the bill.
“I do believe that we can enact meaningful health-care reforms that put the patient and health care provider back at the center of our health care system, but this bill is not the right answer,” he wrote in a Facebook post.