Pressure mounts for changes to ObamaCare bill

House Republican leaders are coming under intense pressure to change their ­ObamaCare repeal-and-replace bill ahead of a possible floor vote next week.

White House spokesman Sean Spicer on Tuesday said the administration is working with House leadership on a manager’s amendment that would make changes to the legislation. Those changes, which GOP leadership offices declined to discuss, could be aimed at bringing conservatives on board.

Yet any changes to the bill could further alienate moderate members who are worried about lost coverage and price spikes for lower-income and older people. Their fears were heightened by a Congressional Budget Office (CBO) report, released Monday, that found the bill could result in 24 million people becoming uninsured over the next decade.

Rep. Ileana Ros-Lehtinen (R-Fla.), who represents a district won by Hillary ClintonHillary Rodham ClintonMaxine Waters is joking about 2020 — but not about Trump How Florida explains our polarized politics Dem senator: Pardoning targets of Russia probe would be 'crossing a fundamental line' MORE in November, came out against the bill on Tuesday. Her opposition could signal movement against the bill, titled the American Health Care Act, among GOP centrists.

“I plan to vote NO on the current #AHCA bill,” Ros-Lehtinen wrote on Twitter Tuesday. “As written the plan leaves too many from my #SoFla district uninsured.”

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At least 13 House Republicans are against the repeal plan in its current form, according to The Hill’s Whip List, with many more undecided.

GOP leaders have little margin for error, with 21 defections likely enough to stop the bill in its tracks.

Adding to the troubles for GOP leadership, Senate Republicans are making clear that the legislation will have to be changed to pass their chamber. Crucially, the changes they are proposing are the opposite of what conservatives in the House want.

One of the proposed changes is an amendment from Sen. John ThuneJohn ThuneSenate heads to new healthcare vote with no clear plan McCain absence adds to GOP agenda’s uncertainty Cornyn: Knowing health plan ahead of vote is 'luxury we don't have' MORE (R-S.D.), a member of Senate GOP leadership, that would increase financial assistance for low-income people under the bill.

Conservatives in the House say the tax credits under the bill are a new entitlement and must be scaled back.

Increasingly, President Trump and the White House appear to be giving leverage to conservatives seeking changes to the bill.

Rep. Mark Meadows (R-N.C.), the chairman of the conservative House Freedom Caucus, has been in contact with top White House officials on a nearly daily basis. And he spent Tuesday in Washington meeting with key healthcare advocacy groups.

“The administration has been engaged and working around the clock to bring all sides together,” Meadows told The Hill, declining to discuss specifics. “I am optimistic that if leadership of the House and Senate is willing to engage in good-faith negotiations, we will find a solution that truly brings down health insurance premiums and addresses the pre-existing conditions in a very effective manner.”

An official at a conservative group said House leadership has moved from saying there would be no changes to the legislation to being more open to some negotiations.

One change to the measure being sought by the conservative Republican Study Committee would move the end of ­ObamaCare’s expansion of Medicaid to 2018 instead of 2020.

But House GOP leadership has pushed back on that change, warning it could jeopardize support from moderates. House Majority Leader Kevin McCarthy (R-Calif.) on Friday called the change “very difficult to do.”

Conservatives also want the bill to repeal ­ObamaCare’s insurance regulations, which they say is necessary to bring down premiums, but it is not clear that those changes would be allowed under Senate rules.

Speaker Paul RyanPaul RyanRyan: CBO's healthcare estimate is 'bogus' Kushner speech to congressional interns delayed Overnight Energy: Exxon sues feds over M sanctions fine MORE’s (R-Wis.) office took a different tack than the White House on the possible manager’s amendment, saying it is “too early to discuss” that.  

Ryan is under intense pressure to bring the healthcare bill over the finish line.

One lawmaker suggested the audio of Ryan declining to defend Trump after October’s release of the “Access Hollywood” tape — reported by Breitbart — was leaked to weaken the Speaker and remind Trump that Ryan was not always in his corner.

“I believe it was intended for an audience of one: Donald TrumpDonald TrumpHow Florida explains our polarized politics Dem senator: Pardoning targets of Russia probe would be 'crossing a fundamental line' Trump lawyers looking into special counsel's potential conflicts of interest: reports MORE,” one House Freedom Caucus member told The Hill on Tuesday.

If Ryan manages to get a bill through the House, it is likely to face a steep climb in the Senate.

Sens. Lamar AlexanderLamar AlexanderSenate panel rejects Trump funding cuts on Energy Department programs Governors-turned-senators meet to talk healthcare With healthcare bill derailed, GOP wonders: What now? MORE (R-Tenn.), chairman of the Senate Health Committee, and Roy BluntRoy BluntOvernight Healthcare: Trump plays hardball on ObamaCare | Senators revive negotiations | CBO says repeal without replace would cost 32M insurance White House working with moderates on new Medicaid proposal Senate GOP revives negotiation over ObamaCare repeal and replace MORE (R-Mo.), another Senate leader, said they support Thune’s push to increase the tax credits under the bill for older and low-income people.

“I do think there are things we can do to tailor the tax credit in a way that makes it more attractive to people and more helpful to people on the lower end and with a phaseout that is a little less steep than what the House has,” Thune told reporters Tuesday.

Thune said he would like the amendment added to the House bill, but “if necessary, it could be in the Senate.”

After a Senate GOP lunch with two House Republican leaders, Sen. Bill Cassidy (R-La.) suggested the House might make changes to its legislation to help older people.

“They did seem to express sympathy for that 60-year-old who currently is making $20K a year,” Cassidy said of Reps. Greg Walden (R-Ore.) and Kevin BradyKevin BradyHealthcare debacle raises pressure for GOP on taxes Trump administration outlines negotiating priorities for NAFTA Charities push GOP for tax reform change MORE (R-Texas), chairmen of the House Energy and Commerce and Ways and Means committees, respectively, who attended the Senate lunch.

According to an example provided by the CBO, a 64-year-old who earns $26,500 a year would see her premiums increase from $1,700 to $14,600 under the Republican system.

“They did not get into specifics about how to address that, but they did acknowledge that was an issue to be addressed,” Cassidy said.

Under the House GOP plan, tax credits phase out for individuals making more than $75,000 a year. For each $1,000 in additional income, a person would get $100 less in credit.

Cassidy suggested Republicans could cut tax credits to people over that $75,000 threshold to help older and low-income people.

“If you look at the phaseout at the top end, it’s pretty generous, and statistically, folks at the top frankly are purchasing insurance on their own,” he said.

“You could scale that back and reapportion the money to those who are lower-income.”

Sen. Pat RobertsPat RobertsOvernight Healthcare: McConnell warns Senate not to block repeal debate | Insurers knock Cruz proposal | WH tries to discredit CBO | Lawmakers propose .1B NIH funding boost Trump: I’ll be ‘very angry’ if Senate doesn’t pass ObamaCare repeal bill Trump: Putin preferred Clinton in the White House MORE (R-Kan.) also said something needs to be done to help older people through the plan.

“There has to be some adjustment made for seniors living in rural areas,” he said. “They’re going to change that bill considerably, I think. But it’s not just to suit the Senate. It’s to get it to final passage and to help people.”

Updated at 8:13 p.m.