Republicans renew the US healthcare bill.

© Reuters. On Capitol Hill you see copies of the amendments offered during a marathon hearing by the House Committee on Energy and Commerce on a possible replacement of the Affordable Care Act.

By Susan Cornwell and Valerie Volcovici

WASHINGTON (Reuters) – Republicans in the U.S. House of Representatives are working on changes to their health care reform bill to provide more generous tax credits for older Americans and add a work requirement for the Medicaid program. for the poor, House Speaker Paul Ryan said Sunday.

Ryan said Republican leaders still plan to move the healthcare bill to a vote in the House of Representatives on Thursday. Speaking on the “Fox News Sunday” television show, he said leaders were working to address concerns raised by grassroots Republicans on the legislation.

Republicans remain deeply divided on health care reform, which is President Donald Trump‘s first major legislative initiative. His goal is to fulfill his campaign promise to repeal and replace the Affordable Care Act, popularly known as Obamacare, the signature health care program of his Democratic predecessor, Barack Obama.

Democrats say the Republican plan could take millions out of health insurance and hurt older, poor and working families while offering tax cuts to the rich.

“We think we should offer even more assistance than the bill currently provides” for low-income people ages 50 to 64, said Ryan, the top Republican in Congress, of the proposed health insurance tax credits. in legislation.

Ryan also said Republicans were working on changes that would allow federal block grants to states for Medicaid and allow states to impose a work requirement for Medicaid recipients without disabilities.

Trump told reporters in a brief conversation aboard Air Force One that he had meetings about health care reform in Florida over the weekend and that the effort to sell the proposal was going well.

He has been asking lawmakers to vote on the bill and won the endorsement of a dozen conservative lawmakers on Friday after a meeting in the Oval Office in which the president approved a job requirement and a block grant option. for Medicaid.

Trump will meet at the White House Monday with Ezekiel Emanuel, an Obama special health policy adviser who helped shape the Affordable Care Act, along with Ryan and Health and Human Services Secretary Tom Price. .

The block grants would give states a set amount of money to cover people in the Medicaid program and provide flexibility in spending decisions. However, there is no guarantee that financing will accommodate future demands.

“TRYING TO SET THE INVOICE”

While Ryan said he felt “very good” about the prospects for the health bill in the House, a prominent Conservative lawmaker, Representative Mark Meadows, told the C-Span “Newsmakers” program that there are currently 40 Republican votes. ” no “in the House. Republicans have a majority in the House, but they cannot afford to have more than 21 defections to pass the measure.

Meadows and two other Republican opponents of the bill, Senators Mike Lee of Utah and Ted Cruz of Texas, met at Trump’s Mar-a-Lago estate in Florida on Saturday “to negotiate with the president’s team, trying to to fix this bill, “Cruz said. CBS’s “Face the Nation”.

North Carolina Republican Meadows said the changes being considered to the Medicaid program would not go far enough if they left the decision to establish a work requirement up to the states.

Price acknowledged the tough negotiations and told ABC “This Week”: “It is a fine needle that needs thread, there is no question about it.”

The healthcare bill would face significant challenges in the Senate even if passed by the House.

Sen. Tom Cotton, a conservative Republican from Arkansas, said the bill would not lower premiums for people in the private insurance market. “It can be fixed, but it’s going to take a lot of work,” Cotton said on CNN’s “State of the Union.”

Moderate Republicans have also raised concerns about the bill, and their concerns are often not the same as those of conservatives.

Speaking on NBC’s “Meet the Press,” Republican Sen. Susan Collins of Maine worried the bill would hurt older Americans and shift Medicaid costs to the states, something critics say a subsidy approach en bloc it would only get worse.

Collins said coverage issues need to be addressed too, citing a Congressional Budget Office report that says 14 million people would lose health coverage under the House bill over the next year and 24 million over the next. decade.

Affordability has been one of the biggest concerns that insurers and hospital groups have raised about the legislation. To the extent that a change in tax credits makes health care more affordable for some people, insurers and hospitals could benefit.

The BlueCross BlueShield Association emphasized the need for affordable replacement when the draft of the healthcare law was published earlier this month. The association represents the BCBS insurers that cover the vast majority of the roughly 10 million people enrolled in 2017 Obamacare plans.