Divided Republicans, Angry Conservatives Over Health Care Reform

© Reuters. House Budget Committee Chair Diane Black and John Yarmuth prepare for the American Healthcare Act marking on Capitol Hill in Washington

By Susan Cornwell

WASHINGTON (Reuters) – Deeply divided Republicans squeezed in their US healthcare reform, backed by President Donald Trump, through a key House panel on Thursday despite defections from three conservatives who consider it too similar to the Obamacare law it is intended to replace.

Trump’s first major legislative initiative still faces an uphill battle in the House floor and later in the Senate despite ongoing efforts by the White House and Republican leaders to satisfy conservative opponents.

The Budget Committee vote ran from 19-17, and Republican Representatives David Brat, Gary Palmer and Mark Sanford, all members of the conservative House Freedom Caucus, joined the panel’s Democrats in voting against. The committee brought together the provisions passed last week by two other panels into a single bill, helping pave the way for a later vote in the House.

Republicans, who control Congress and the White House, couldn’t afford to lose more than three of their ranks on the committee to pass.

“I don’t think we’re anywhere close to passing it,” Brat said after the vote, noting that both Republican conservatives and moderates had problems with the bill.

The Affordable Care Act of 2010, the iconic legislative achievement of former President Barack Obama, enabled approximately 20 million uninsured Americans to obtain health coverage. About half of them were through expanding the law’s eligibility and increasing funding for the government’s Medicaid health insurance program for the poor.

The close vote illustrated the problems Republican leaders may encounter in mustering enough votes in their party to win approval in the House amid a unified Democratic opposition. The measure now goes to the Rules Committee before reaching the House floor.

The Congressional Budget Office, a nonpartisan Congressional agency, forecast Monday that the legislation would increase the number of Americans without health insurance by 24 million by 2026, while cutting $ 337 billion from federal budget deficits during the same period. period. The bill faces opposition from major healthcare providers, including doctors and hospitals.

“We’re on the road and on the agenda,” said House Speaker Paul Ryan, who unveiled the legislation last week and is its main advocate in the House, after the committee vote. He added that while the main parts of the bill “will remain exactly as is,” Republicans were making unspecified “improvements and refinements.”

Ryan told a news conference that Trump was “deeply involved” and “helping to bridge gaps” among Republican lawmakers to achieve a consensus plan.

‘CONSTITUENCE OF ONE’

Conservatives were unfazed. “There is no natural constituency for this bill,” said Republican Rep. Raul Labrador, another member of the Freedom Caucus.

“The left is really mad about it. The right is really mad about it. The media is really mad about it. And so far it seems to be a constituency of one, who are members of Washington, people who are just trying to get something happened. so they can move on to the next number. ”

Trump administration officials and House Republican leaders have said they expect the bill to reach the House floor by the end of the month so that it can reach the Senate before the legislators’ recess in mid-April. .

Conservatives want a quicker end to the Obamacare Medicaid expansion, which the bill has set for 2020, and they want to add work requirements for some Medicaid recipients. They also call age-based tax credits to help people buy insurance on the open market as an unwise new right.

The White House said it was discussing changes with House Republican leaders. Trump told a Fox News interviewer on Wednesday that much of the bill would still be negotiated, especially as it moves from the House to the Senate.

Conservative advocacy groups praised Republicans who voted “no.” Growth Club President David McIntosh said it doesn’t make sense for Ryan and Budget Committee Chair Diane Black to force Republicans to “walk on the grid and vote for a bad bill they’ve already done. admitted that it should be changed. “

Black asked fellow Republicans who were hesitant not to “cut the discussion down” by voting no.

After passing the legislation, the panel adopted four non-binding Republican recommendations for changes before moving to the House floor, including one from conservative Palmer on adding work requirements for Medicaid recipients without children and without disabilities.

The other recommendations called for people no longer to be encouraged to sign up for insurance through Medicaid, giving states more flexibility to design Medicaid programs and changing the bill’s tax credits to help people more. low income.

Democrats have called the Republicans’ plan a blow to the elderly and the poor, while cutting taxes on the rich.

Rep. John Yarmuth, the committee’s top Democrat, said the legislation “is not a health bill; it is an ideological document.” He said the bill envisioned a “fantasy land where young people don’t get sick, and apparently they don’t age either, because they don’t have to worry about being shut out of the market.”