It’s still not clear whether GOP leaders will have enough votes to pass their Obamacare repeal-and-replace bill next week, even after President Trump on Friday endorsed changes that would shift the bill further to the right.
Republican Study Committee Chairman Mark Walker said the White House signed off on two changes to the American Health Care Act: allowing states to impose work requirements for Medicaid beneficiaries; and allowing them to receive their federal Medicaid funding via a block grant, instead of the capped per-person payments already included in the bill.
Majority Whip Steve Scalise said the changes would “add significantly” to their whip count, but didn’t say whether he had the votes yet to pass the legislation. He also said Trump is fully behind the bill.
But House Freedom Caucus Chairman Mark Meadows insisted there were still not enough votes for the bill to pass, and he took issue with the changes discussed Friday.
“Optional work requirements. Let me ask you a question: Is the definition of ‘oxymoron’ mandatory optional work requirements?” he said.
Meadows also said he doesn’t expect any states to choose a Medicaid block grant over the bill’s per-capita caps.
“I don’t know of one state that will pick a block grant,” he said. “But it’s good that they can pick a block grant if they want it, but it would be interesting based on the bill that is written to see if there is more than a handful of states that would actually pick block [grant].”
Without any Democratic support, GOP leaders can only afford to lose 21 votes in the House.
Rep. Paul Gosar said Friday’s changes didn’t change his mind. He and other Freedom Caucus members remain skeptical of leaders’ assertions that they can change elements of the law through administrative action or further legislation. They want the House to go much further in repealing Obamacare, even if it means challenging the Senate’s parliamentary rules.
Still, not all Freedom Caucus members are against the bill. Rep. Gary Palmer, who was among the members who met with Trump on Friday, said he will vote for the bill after the president agreed to Medicaid changes. Palmer, along with Reps. Dave Brat and Mark Sanford, had voted against the bill Thursday in the House Budget Committee.
Palmer’s reversal gave leadership some hope of peeling off more members of the Freedom Caucus before Thursday’s floor vote. House Republican leaders, in addition to Trump, Vice President Mike Pence, and Health and Human Services Secretary Tom Price, will be working the phones over the weekend, and leadership is especially counting on Trump to twist Freedom Caucus members’ arms.
Still, even with more conservatives on board, leadership must also avoid defections from more moderate Republicans in swing districts.
Rep. Mario Diaz-Balart, whose district has one of the highest concentrations of Obamacare enrollees, said he still has major concerns with the bill. “If you’re over 55 and you’re poor … what happens to those folks now?” he said.
Rep. Robert Aderholt had similar concerns, and said he told Trump he was worried about low-income seniors facing significantly higher premiums. But he said that he felt better about the legislation after the White House meeting.
“These are people that are counting on him, that were looking to him for guidance. And he said, ‘I hear you. This is a very important issue. We are dealing with it,’” Aderholt said. “He said, ‘Those are the people that voted for me and I am not going to let them down.’”
Even if the votes come together in the House, the bill will likely face a whole new round of obstacles in the Senate. Conservatives, including Sen. Rand Paul, have expressed concerns similar to the Freedom Caucus’s, while more-moderate Republicans, including Susan Collins and Dean Heller, say they can’t support the bill because of its deep cuts to Medicaid.
Those three alone could sink the bill. And many other senators are concerned about voting for a measure that would, according to the Congressional Budget Office, lead to 24 million more uninsured Americans by 2026.
But for now, House Republican are only focused on something that can pass their chamber.
“I think the Senate is worried about having to vote on anything, which is pretty typical,” Rep. Tom Cole told National Journal. “These demands that we write something that they can pass; they should write something that they can pass. That’s not really our job.”
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