House Republicans' Obamacare Plan Lacks Party Buy-In

House Republicans' Obamacare Plan Lacks Party Buy-In
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House Republicans released their long-awaited bill dismantling and replacing the core of the Affordable Care Act Monday evening, but will have to overcome major hurdles -- erected by members of their own party -- getting the legislation to President Trump’s desk.

One key conservative, Rep. Jim Jordan, said that the legislation “is not even close to what we told the voters we’re going to do."

The bill would repeal key portions of Obamacare, including the tax penalties for the individual and employer mandates and the tax subsidies and, eventually, the Medicaid expansion, while keeping the most popular provisions, including protecting those with pre-existing conditions and allowing children to stay on their parents’ health plans until age 26.

But while there’s broad agreement within the Republican Party for those provisions, there were early signs Monday that aspects of the legislation trouble both conservatives and moderates. GOP leaders and the key committees continued adjusting the legislation through the weekend and into Monday to assuage those concerns on both sides, but it remains to be seen whether they can garner enough Republican support given that Democrats wholly opposed to the bill. Their goal is to pass it through the House by the end of this month and the Senate two weeks after that, which will require a major sale from both leadership and the president to bring wary lawmakers on board.

“I'm confident we are going to pass this and deliver on President Trump's promise to repeal and replace,” Rep. Kevin Brady, chairman of the House Ways and Means Committee said on Fox News Monday evening.

But several key conservatives, namely members of the House Freedom Caucus, expressed hesitation with the legislation hours after it was unveiled. Rep. Justin Amash tweeted that it was “Obamacare 2.0” and Jordan said he didn’t think it met the promises Republicans made to voters. Their main concern is the creation of new tax credits to help individuals afford health coverage, something that conservatives say amounts to a new entitlement program. The credits would range from $2,000 annually for individuals under 30 to $4,000 for those over 60.

To try to lessen those concerns, the legislation would phase out the tax credits for individuals making more than $75,000 a year – knocking $100 off the credit for every $1,000 in additional income.

Conservatives were also frustrated that it would delay the repeal of certain Obamacare taxes until 2018, and with the fact that the Medicaid expansion would be preserved through 2019, when it would freeze but allow current enrollees to remain on the program. 

“We put on President Obama’s desk a bill that ended Medicaid expansion after a couple years, a bill that ended all the tax increases and a bill that had no new entitlement, but we’re going to put a bill on a Republican president’s desk a bill that keeps tax increases in place, keeps Medicaid expansion in place for four years and a bill that starts a new entitlement?” said Jordan, a key House conservative. “A Republican Congress is going to put that on a Republican desk? That makes no sense."

Sen. Rand Paul echoed this sentiment in a tweet:

Rep. Mark Meadows, the chairman of the Freedom Caucus, said on Fox News that he shared similar concerns, and said his fellow lawmakers would need to find a “sweet spot” to bring conservatives on board.

“We’ve got to do better, and hopefully, with some amendments, we can do that,” Meadows said. The Freedom Caucus will meet as a group Tuesday evening in Washington to discuss the legislation.

There were hopeful signs, however: Rep. Mark Walker, chairman of the Republican Study Committee, had sided with Jordan and Meadows against a draft proposal of the legislation that leaked last month, but said adjustments to the final bill signified “the right direction.”

But while there is push-back from conservatives, there are also objections from moderates, particularly those from states that expanded Medicaid under Obamacare. Four senators – Rob Portman of Ohio, Cory Gardner of Colorado, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska – sent a letter to Majority Leader Mitch McConnell Monday, just hours before the House proposal was released, expressing serious concerns with the Medicaid portion of the draft House proposal from last month.

The senators said that while they supported broad structural changes to Medicaid, the early proposal “does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.”

It’s unclear yet whether the changes to Medicaid in the new legislation would assuage those concerns. In the bill released Monday, the Medicaid expansion would be continued through 2019 and enrollees on it at that point would be able to stay on the program, though the expanded enrollment would “freeze” on Jan. 1, 2020.

At that point, the proposal would turn Medicaid into a per-capita allotment, capping the limit on how much the federal government pays states per enrollee in the program, a massive shift in the structure of the entitlement program that Republicans have long sought.

Both the House Ways and Means Committee and Energy and Commerce Committee will mark up the legislation Wednesday -- the first opportunity to address some of the above concerns and indicating whether Republicans will be able to bring the party together on their proposal.

“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,” Speaker Paul Ryan said in a statement. “This will proceed through a transparent process of regular order in full view of the public.”

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at jarkin@realclearpolitics.com. Follow him on Twitter @JamesArkin.

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