The scathing nonpartisan analysis of Republicans’ Obamacare repeal plan is hardening GOP divisions and raising doubts about whether the party in Congress can meet a self-imposed deadline to pass legislation by early April.
With the Congressional Budget Office projecting that up to 24 million fewer people would have health insurance under the bill, and that premiums would rise for several years before falling, senators say the party must do better. They’re pressing for significant changes that tilt the bill toward centrists, including making its tax credits more generous for lower-income people.
But such changes would infuriate House conservatives, who have dismissed those very credits as a “new entitlement.” The right flank is also clamoring to roll back health insurance for some low-income people more quickly, saying House leaders are tempting an embarrassing floor vote next week if they push ahead without conservative amendments.
The impasse is causing confidence to plummet that Republicans can capitalize on control of Washington to enact sweeping health care reform.
“The way I see this going right now, we’re probably going to head to the August recess with Obamacare. And that’s scary,” said one House Republican close with leadership, who requested anonymity to speak frankly.
House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have an increasingly difficult task amid schisms over whether Obamacare repeal should merely save money, or cut premiums, or preserve some form of the law’s coverage gains. Caught in the middle of a years-long effort to scuttle the health care law, party leaders argue the bill at hand is the only framework that can become law.
Proponents argue that premiums will eventually decrease and that Republicans’ goal was never to force people to have insurance. But it’s not a winning argument among the rank and file in the Senate or among moderates in the House. This week, three centrist House Republicans said they would vote against the bill in its current form.
Plus, the bill is a far cry from President Donald Trump’s promise to cut costs and provide better coverage, even “insurance for everybody” as he once vowed. The conflicting messages have Republicans wondering what problem they are trying to solve.
“We’ve got to come back to defining what is success. What is the objective we are trying to accomplish here? We saw premiums go up, not down. And that to me is not success,” Sen. Steve Daines (R-Mont.) said of the CBO report. “That’s not acceptable. To me, we’ve got to find a better path forward.”
“Fourteen million people would lose insurance in a year relative to baseline. That’s something that folks are going to be concerned about,” said Sen. Bill Cassidy (R-La.). “Who wants to see 14 million people lose coverage?”
Despite the gripes, GOP leaders refuse to concede their deadline of passing a repeal bill within the next month is unrealistic. It’s a negotiating tactic intended to create urgency, lawmakers said, out of fear the party could dither endlessly without a target date. House GOP leadership will begin whipping the bill this week to get a tentative vote count, and intend to hold a vote next week.
But leaders on both sides of the Capitol now admit that the yawning gap between the House and Senate may require far more intricate negotiations than simply jamming bills through each chamber before the April 8 Easter recess. In the House, for instance, leadership is considering an amendment to allow states to impose work requirements on healthy Medicaid beneficiaries, which could lure conservative votes without repelling moderates.
Senators say they’ve got some ideas of their own, including beefing up the tax credits and helping states deal with the reversal of Obamacare’s Medicaid expansion.
“We’re going to consider trying to work on the coverage numbers and get those better,” said Senate Majority Whip John Cornyn (R-Texas) in an interview. He would not rule out bicameral negotiations between the House and the Senate. “It may be well be this goes back to a conference committee.”
The public sniping has triggered triage at the highest levels of government. Conservatives from both chambers are visiting the White House this week to try to persuade Trump to back their pitch to push the bill further right. Vice President Mike Pence, Health and Human Services Secretary Tom Price, as well as two key House chairmen, Reps. Greg Walden of Oregon and Kevin Brady of Texas, visited the Senate GOP lunch on Tuesday to try and calm nerves over the brutal CBO score, attendees said. They emphasized that Republicans plan to do far more than just the current proposal under consideration.
But the most immediate concern is ensuring a repeal bill can pass the House.
“The worst thing we can do is do a half-assed job,” said Rep. Ted Yoho (R-Fla.), a member of the House Freedom Caucus who says he will not support the current bill. “If we don’t deliver on what we were told to do, we won’t get voted back in. Nor do I feel we deserve to be back in.”
White House advisers on Monday were readying a major push to give the far right some sort of “significant” concession, skittish that House whips couldn’t pass the bill without more conservative support. One idea being considered: Phasing out the Medicaid expansion in early 2018 instead of Dec. 31, 2019.
House GOP leaders, however, are pushing back against the idea because, as Rep. Charlie Dent (R-Pa.) said, it “would cost a lot of votes.”
A quicker phaseout would also be frowned upon by the Senate, where more than a dozen senators are worried about how low-income people and elderly constituents will be treated by the House proposal. They could lose coverage altogether or see their premiums skyrocket.
Senators are considering taking whatever the House is able to pass and beefing up tax credits for low-income people to help bring down premiums and increase coverage numbers, multiple Republican sources said. John Thune of South Dakota, the No. 3 GOP senator, is one of the lead proponents of that effort.
The whole purpose of this is to deliver assistance to the people that really need it,” Thune said in an interview.
Also under consideration is injecting billions of dollars into states’ “stabilization” accounts to narrow the coverage gap between Obamacare and the House’s repeal-and-replace bill. Cassidy said he’d want prefunded Health Savings Accounts for low-income people who would otherwise struggle to sock away savings for health care.
Some of those proposals could be paid for by slashing tax credits for wealthier Americans. But several sources said it might require using some of the $377 billion in savings from the bill to help prop up coverage for people who would lose it. Those savings are one of the few bright spots from the CBO score, but paying for more generous tax credits and stabilization accounts would cut into the bill’s deficit reduction and turn off undecided conservatives.
That’s unlikely to go over well in the House, which is generally more conservative than the Senate. And the House would have to vote on any changes made by the Senate.