Rift in GOP threatens ObamaCare repeal

House Republicans are facing a major split on ObamaCare repeal that threatens to stall the effort.

Members of the conservative House Freedom Caucus late Monday vowed to oppose any ObamaCare repeal bill that doesn’t go as far as what Congress passed in 2015. 

But the bill being pushed by the Freedom Caucus would repeal ­­ObamaCare’s expansion of Medicaid, an option that centrist Republicans are wary of supporting, particularly in the Senate.

Asked about the Freedom Caucus’s demand to simply pass the 2015 repeal bill again, Rep. Fred Upton (R-Mich.) said he didn’t think it would attract enough votes to pass.

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Upton, like many other more centrist lawmakers, argues Republicans should work out a replacement plan before voting to repeal the Affordable Care Act. 

“I think it becomes a math problem to get [a majority vote] if people don’t know what that replacement piece looks like, so the idea of we’ll repeal it, trust us, doesn’t have a lot of weight,” Upton said.

The emerging divide is a major test for Republican leaders. Unless they can bridge the gap, it’s unclear how an ObamaCare repeal bill can pass as scheduled this spring.

The Freedom Caucus has roughly 40 members — enough votes to stop legislation in its tracks if Democrats are united in opposition.

In the Senate, meanwhile, Republicans have only a slim, two-seat majority, and several members have major reservations about repealing the Medicaid expansion.

Some Democrats are hoping the GOP divisions mean ObamaCare repeal will never pass.

“This is very big,” Jon Favreau, a former aide to President Obama, wrote on Twitter of the Freedom Caucus’s stance. “GOP doesn't have enough votes in the Senate to end Medicaid expansion, which means they wouldn't be able to pass anything.”

With the path ahead uncertain, Vice President Pence met Tuesday with Upton and the “Tuesday Group” of centrist Republicans in Congress. Upton said that in the meeting, Pence “reaffirmed the idea that the replacement piece ought to be part of repeal; people ought to know what's going on.” 

House Republican leaders are planning to include some elements of replacement in their repeal bill, including tax credits, an expansion of Health Savings Accounts, changes to Medicaid and high-risk pool funding.  

House conservatives are open to some of those ideas but want to pass a repeal bill quickly. Elements of a replacement, they say, could be handled in a separate bill. 

Conservative Rep. Trent FranksHarold (Trent) Trent FranksArizona New Members 2019 Cook shifts 8 House races toward Dems Freedom Caucus members see openings in leadership MORE (R-Ariz.), leaving a Freedom Caucus meeting Monday night, said he feared that the repeal effort is in “mortal danger” and warned against Republican senators and other lawmakers backing down from their repeal promise. 

“If there's any excuse possible, now that we're shooting real ammunition, there are maybe some people that will get weak-kneed,” Franks said. 

The Senate is moving slower than the House, and is where the 2015 repeal bill could face particular difficulty.

“I think it’s impractical to say — they’re saying repeal everything, even those things the parliamentarian says we can’t repeal, and then put them back in place,” Sen. Bill Cassidy (R-La.) said Tuesday when asked about the Freedom Caucus’s position. “It’s an incredibly inefficient process, which gives power to the folks who want to say no. I think we want to give power to the folks who want to say yes.” 

Cassidy has sponsored a bill that would give states the option of keeping ObamaCare. That measure has drawn fierce opposition from conservatives. 

Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderThe Hill's Morning Report - How will Trump be received in Dayton and El Paso? McConnell faces pressure to bring Senate back for gun legislation Criminal justice reform should extend to student financial aid MORE (R-Tenn.), the chairman of the Senate Health Committee, has talked of the need for a methodical, pragmatic approach that he dubs “repair” of ObamaCare, rather than “repeal,” a far cry from conservatives’ goal. 

Dan Holler, vice president of the conservative group Heritage Action, sought to dial up the pressure on Alexander Tuesday. He noted that the Tennessee Republican — like 51 other Republicans — voted for the repeal bill in 2015.

“[Alexander’s] plan is sort of a nonstarter in the House, and he voted for the 2015 bill that President Obama vetoed,” Holler said. 

Several conservative senators, including Sens. Mike LeeMichael (Mike) Shumway LeeMcConnell, allies lean into Twitter, media 'war' Conservatives buck Trump over worries of 'socialist' drug pricing Criminal justice reform should extend to student financial aid MORE (R-Utah), Rand PaulRandal (Rand) Howard PaulGraham promises ObamaCare repeal if Trump, Republicans win in 2020 Conservatives buck Trump over worries of 'socialist' drug pricing Rand Paul to 'limit' August activities due to health MORE (R-Ky.) and Ted CruzRafael (Ted) Edward CruzIs this any way for NASA to build a lunar lander? GOP strategist predicts Biden will win nomination, cites fundraising strength 3 real problems Republicans need to address to win in 2020 MORE (R-Texas), are also pushing to stick with the 2015 repeal legislation. 

How to deal with the expansion of Medicaid is one of the thorniest issues that Republicans face. Many Republican senators, and some House members as well, come from states that expanded the program and want to protect it in some form. 

Sen. Rob PortmanRobert (Rob) Jones PortmanSchumer blasts 'red flag' gun legislation as 'ineffective cop out' McConnell faces pressure to bring Senate back for gun legislation Shaken Portman urges support for 'red flag' laws after Ohio shooting MORE (R-Ohio) last week hosted a meeting of Republican senators from states that expanded Medicaid to discuss the issue, and Upton said he raised it during the meeting with Pence.

“I specifically talked about Medicaid-expansion states,” Upton said. “In Michigan we have 600,000 Michiganders [enrolled] and so we need to find a way to resolve this, and I actually think we're making some progress.”

Rep. Brett GuthrieSteven (Brett) Brett GuthrieOvernight Health Care — Campaign for Tobacco-Free Kids — Poll finds Trump vulnerable on health care in battleground states | HHS must respond to petition on abortion referral ban by Thursday | Wyden presses health officials about CBD regulations Lawmakers map out path forward on Medicare Part D The Hill's Morning Report - In exclusive interview, Trump talks Biden, Iran, SCOTUS and reparations MORE (R-Ky.), another senior Energy and Commerce Committee member, said lawmakers are still figuring out how to handle Medicaid, even as they look to restructure the program to cap federal payments. 

Leaders are meeting with rank-and-file members in sessions this week to discuss ObamaCare plans. 

Asked if the push to pass the 2015 repeal bill is complicating efforts in the Senate, Sen. John CornynJohn CornynThe Hill's Morning Report - Trump hews to NRA on guns and eyes lower taxes The Hill's Morning Report - Trump on defense over economic jitters Democrats keen to take on Cornyn despite formidable challenges MORE (Texas), the No. 2 Senate Republican, deflected the question, noting that the House is going first. “I think you’ll need to ask the House,” he said. 

The 2015 repeal bill scrapped ObamaCare’s mandates and taxes; its subsidies to help people afford coverage; and its Medicaid expansion.

"We're playing with live rounds this time,” said centrist Rep. Charlie Dent (R-Pa.). “We're playing with live rounds and we have to have a fully developed replacement plan." 

Lauren Clason contributed.