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Trump, GOP push for coalition on health care bill

March 17, 2017

House Republicans are pushing forward with their repeal of the Affordable Care Act, working feverishly to strike a delicate balance between moderates and conservatives to secure passage of their health-care replacement plan late next week.

House Majority Leader Kevin McCarthy announced the likely vote for next Thursday, seven years to the day when President Obama signed his signature domestic legislation into law.

For Republicans in the House, the vote would cap more than half a decade of campaign promises to repeal and replace the law, though the legislation still faces skepticism and concerns from a number of GOP senators.

The wrangling by the White House and leadership on Capitol Hill has been like piecing together a member-by-member puzzle, dealing with myriad complaints on different aspects of the legislation. But a tough calculus remains heading into next week: Members on either end of the Republican ideological spectrum are still extremely concerned about the legislation, if not outright opposed to it, and any changes that assuage one group are likely to alienate another.

A number of changes have been floated to address those various concerns, but negotiations remained a work in progress as of Friday morning. The legislation is likely to be considered in the Rules Committee Wednesday, when it will be clear precisely what amendments to the bill will be allowed before it reaches the House floor as early as Thursday, according to Republican members and aides.

The party moved closer to securing the necessary support for the bill Friday when President Trump announced that he had secured backing from 13 conservative lawmakers during a meeting at the White House.

“I want everyone to know I am 100 percent behind this,” Trump said Friday morning after meeting with members of the Republican Study Committee — remarks that aides in the House shared widely to spotlight progress being made.

“I think that the support has built for it dramatically over the past 24 hours,” Rep. Bradley Byrne said after leaving a meeting with Health and Human Services Secretary Tom Price Friday morning.

But that doesn’t mean Republicans have solved all their problems.

Opposition from the most skeptical members of the conference remains steadfast, and it is unclear whether enough of them will shift to secure passage.

While the conservative Republican Study Committee may have moved toward supporting the legislation, serious problems persist with the ultra-conservative House Freedom Caucus as well as the moderate Tuesday Group. In many cases, the changes the two sides are pushing for are diametrically opposed, making it extremely difficult to piece together an approvable package.

The two main issues involve tax credits to help people afford insurance, and the significant changes planned for Medicaid.

On the moderate side, lawmakers are concerned about the significant losses in coverage projected by the Congressional Budget Office earlier this week. They want to see more funding for tax credits aimed at helping the elderly and poor pay for health plans. Currently, the legislation would have age-based tax credits providing as much as $4,000 annually to those over 60, though the CBO reported that premiums could rise significantly for that population under the legislation.

Rep. Charlie Dent, the Tuesday Group chairman, said he and other members hope to adjust the tax credits in the legislation to provide more support for the elderly and poor, and several Republican lawmakers said changes to the tax credits are still being considered. But members of the Freedom Caucus are wholly opposed to tax credits in the bill, and are unlikely to support more resources to provide them.

And on Medicaid, the legislation freezes expansion (created under the Affordable Care Act) at the end of 2019 to allow an adjustment for the populations of those states, before turning the program into a fixed sum of money per enrollee in each state. Conservatives want to freeze the expansion at the end of this year, a proposal Dent labeled a “non-starter” for moderates.

Both groups claim to have enough votes to swing the bill in their direction. Freedom Caucus Chairman Mark Meadows, who has been in near constant communication with the White House on the legislation, said earlier this week the group has enough votes to block the legislation without changes. And Dent said Thursday that there are a “fair number” of moderates opposed to making the bill more palatable to conservatives.

Asked to be more specific, he said, “Enough to make a difference.”

Trump and House leadership did make significant progress Friday afternoon when the president announced that some members of the Republican Study Committee were ready to support the legislation.

The group secured fixes to Medicaid, including giving states the option to block-grant funds for the program rather than receive a set allotment per person, and to give incentives to states to create work requirements for those in the program.

But it was unclear whether those changes actually moved the legislation closer to passage. Meadows, the Freedom Caucus chair, told reporters that the support secured by Trump Friday didn’t change the whip count he had tallied, and said there were as many as 40 lawmakers opposed to the bill (leadership aides have disputed Meadows’ whip calculation).

Meadows and other Freedom Caucus leaders are crafting an amendment to the legislation that they have indicated would secure conservative support, and he said the provision is likely to be released next week. But it’s unlikely to win moderate support and thus not expected to end up in the final version.

It remains to be seen whether the president and Speaker Paul Ryan can persuade enough members on either side to support the legislation, but the negotiating is likely to ramp up significantly ahead of the vote. Many members felt the president’s strong support Friday helped moved the needle, and strong public support for the bill after he holds a rally in Kentucky Monday evening could be enough to bring it across the finish line.

“I think the president’s the ultimate salesman on this,” Byrne said. “I think we’re real close.”

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