Five things to know about the CBO's report on Paul Ryan's ACA replacement
As Speaker Paul Ryan delayed a vote Thursday on the GOP’s controversial health care bill, two Kansas City-area Republicans remain undecided about whether to support the legislation.
Their reluctance to stake out a public position, coming from two lawmakers who rarely buck party leadership, underscores how difficult it will be to build a Republican coalition to pass the bill in the face of united Democratic opposition: Efforts to win over hardliners could end up preventing more moderate members from supporting the bill.
One holdout is Rep. Sam Graves of Missouri, a longtime member of Congress whose brother, Todd Graves, heads the Republican Party in Missouri.
The other is Kansas Rep. Kevin Yoder, a Republican running for re-election in a district Hillary Clinton won in November. He’s coming under heavy pressure from hospitals and health care organizations in his district to vote no, but he’s also a member of the deputy whip team tasked with shoring up support for the bill in the House.
The American Health Care Act has faced resistance from health care advocates who warn that it would rapidly decrease the number of insured people. It also has prompted a backlash from conservative groups who say it would preserve too many regulations enacted under former President Barack Obama as part of his signature health care reforms.
Yoder, an Overland Park Republican, met with health care leaders from the region last week and received stern warnings about the potential impact of the bill, which would repeal the 2010 Affordable Care Act, also known as “Obamacare.”
“I think he is becoming aware of the pitfalls,” said Brenda Sharpe, president and CEO of the REACH Healthcare Foundation, a nonprofit group that works to improve health care access in the Kansas City area. “He got a lot of pushback on that call last week.”
But Yoder’s leadership role on the House GOP’s deputy whip team makes it difficult for him to oppose the legislation he’s supposed to be persuading his colleagues to support.
Yoder’s office said Thursday that the congressman told Republican leadership that repealing an Affordable Care Act requirement for insurers to cover pre-existing conditions would be a nonstarter for him.
The idea is a point of negotiation between Republican leaders and members of the far-right House Freedom Caucus as GOP leaders try to garner support for a bill to repeal the Affordable Care Act.
But it’s also a fairly safe position for him to take. Asked by reporters Thursday if the president was open to removing protections for pre-existing conditions from the bill, White House spokesman Sean Spicer replied, “I think that’s been something that he’s been very clear needs to stay in there.”
Yoder is the only Kansas member of the U.S. House who has not taken a clear position on the bill. Fellow Republican Reps. Lynn Jenkins and Roger Marshall have voiced support for the legislation.
Sharpe said that supporting the bill would put Yoder “out of step with the business and industry leaders in Johnson and Wyandotte (counties) that have typically supported him in the past.”
Among Missouri lawmakers, Graves, a Tarkio Republican whose district includes North Kansas City, also has not taken a firm stance.
His brother, Missouri GOP Chairman Todd Graves, did not return a phone call requesting comment. Kristen Blanchard Ansley, a spokeswoman for the state’s Republican Party, said the brothers have not discussed the legislation.
Sam Graves wasn’t available in his Washington office Thursday, and his spokesman, Wes Shaw, said the congressman wouldn’t issue a statement until after the vote.
Graves was undecided last week when he said in a statement that while he supported repealing the Affordable Care Act, “the process cannot be rushed through Congress.”
“This is one step out of many,” he said, “and we have a long way to go.”
Yoder and Graves could play a crucial role in either halting or advancing the legislation. U.S. Rep. Emanuel Cleaver, a Kansas City Democrat, has already voiced his opposition to the bill.
With Democrats unified against the bill, Republican leaders can only afford to lose 22 votes from their own party and still pass the bill. When it became clear Thursday afternoon that they couldn’t guarantee the votes, GOP House leadership decided not to bring the bill for a vote as planned.
An analysis by the Congressional Budget Office found earlier this month that the number of uninsured people in the United States would increase by 14 million in 2018 because of the repeal of the Affordable Care Act’s mandate. That number would go up in the following years as changes to Medicaid went into effect.
Tim Van Zandt, vice president of government and community relations for St. Luke’s Health System, which runs hospitals in both Kansas and Missouri, said this will increase health care costs for people with coverage.
“If more people come in uninsured and we’re required by federal law to take care of them, those costs have to be covered somewhere by someone,” he said.
Van Zandt said that based on last week’s meeting, he expects Yoder to vote in favor of the bill.
“I will say that we were pretty candid with him, and he seemed to be pretty defensive about it and already seemed like he had made up his mind,” Van Zandt said. “If there’s a vote, he’ll end up supporting it.”
C.J. Grover, a spokesman for Yoder, said in an email Wednesday that as “changes are being made to the bill, we are taking them into account. Congressman Yoder will make a decision based on the final product and continued feedback from constituents.”
On his way into a meeting of the Republican caucus at in basement of the U.S. Capitol’s visitor center Thursday night, Yoder didn’t say how he planned to vote. “The situation is fluid,” he told The Star. “There’s been a lot of conversations today, and we’ll know more in a little bit.”
The meeting, attended by top White House aides Steve Bannon, Reince Priebus and Mick Mulvaney, stretched late into the night. Republicans who left said Mulvaney had told them President Donald Trump was done negotiating. He’d agreed to conservatives’ demand to repeal essential benefits such as maternity care and mental health that insurance companies were required to provide under the Affordable Care Act.
Now he wants an up-or-down vote Friday. If the bill didn’t pass, he would move on to tax reform, leaving Obamacare in place.
The bill also would block states from expanding Medicaid after March 1.
A letter from the Alliance for a Healthy Kansas that was sent to the state’s congressional delegation this week contends that this amendment “seems to be aimed at Kansas, where expanding KanCare has broad support and is moving forward in the state legislature.”
Sharpe said this amendment has made the already controversial bill “much more concerning” for Kansas health care advocates because the March 1 deadline “would essentially cut Kansas out.”
House leaders’ amendment also includes a provision to prevent money from health care tax credits from being used to pay for abortions, a provision that helped win the support of U.S. Rep. Vicky Hartzler, a Harrisonville Republican who was previously undecided.