Health Care

GOP leaders seek healthcare votes from competing factions

Greg Nash

House GOP leaders are trying to navigate the concerns of competing factions to win enough support for their ­ObamaCare repeal-and-replace measure ahead of a crucial Thursday vote.  

Here’s a look at the different groups, and what could get them to vote for the plan.


Freedom Caucus

The conservative House Freedom Caucus remains the chief obstacle to passage of the bill.

Freedom Caucus Chairman Mark Meadows (R-N.C.) said after the group met Tuesday afternoon that there are “without a doubt” still not enough votes to pass the healthcare legislation.

The Freedom Caucus’s main concern is that the GOP bill does not repeal ­ObamaCare’s insurance regulations, such as “essential health benefits” that mandate which healthcare services an insurance plan must cover. The conservatives say repeal of that rule is necessary to bring premiums down.


But the House committees that wrote the bill counter that those provisions can’t be repealed under Senate budget rules that prevent the repeal bill from being filibustered.

A few Freedom Caucus members have announced support for the House bill.

Rep. Gary Palmer (R-Ala.) said he would vote yes after meeting with President Trump last week, and Rep. David Schweikert (R-Ariz.) confirmed Tuesday that he would vote affirmatively.

But Meadows, the key Freedom Caucus member, remains a “no,” even after pressure from Trump and a one-on-one meeting Tuesday with Vice President Pence.

“Does he want me to vote for it? Yes,” Meadows said of his meeting with Pence. “Did he put pressure? Yes. Was it brass knuckles and bare fists? No.”


Tuesday Group

Moderate Tuesday Group members are split on the measure, even after a meeting with Trump at the White House Tuesday.

Rep. Tom MacArthur (R-N.J.), co-chairman of the Tuesday Group, backed the bill after changes were made to the legislation by leadership.

Those changes included a placeholder provision intended to allow the Senate to add roughly $85 billion to increase tax credits under the bill for older people, who many lawmakers worry will face price spikes under the GOP plan.

However, Rep. Charlie Dent (R-Pa.), another co-chairman of the Tuesday Group, said that after he and 15 other members met with Trump, he still had “serious reservations” about the bill.

“I had reservations going in, and I still have reservations going out,” Dent told reporters, adding that he wants to see an updated score from the nonpartisan Congressional Budget Office (CBO). The CBO’s initial report found the plan would cause 24 million people to lose health insurance over the next decade.

Dent said he told the president that the bill still does not address the issue of refundable tax credits “directly” or absolve his concerns about ­ObamaCare’s Medicaid expansion, and he also wants to see the Planned Parenthood defunding language separated from the bill.

“There may have to be changes before Thursday to get votes,” Dent said.

Another centrist after the White House meeting said he was now a firm “no.”

Rep. Leonard Lance (R-N.J.), a top Democratic target in 2018, told reporters he would not back the legislation.

“I don’t think that it provides affordable healthcare, and I think we should work on issues like purchasing policies across state lines,” he said.


New York Republicans

A special provision for New York state’s Medicaid program has helped win over wavering Republicans in that state.

Rep. Chris Collins (R-N.Y.) said Tuesday that, because of the provision, he thinks “we’ll get eight out of our nine Republicans” in New York, with the lone “no” vote being Rep. John Katko.

Rep. Dan Donovan (R-N.Y.), however, said he remains undecided and actually opposes the New York Medicaid provision. It does not apply to New York City, which he represents. He also has concerns about ending Medicaid expansion.

The provision cuts off federal reimbursements for state Medicaid funds raised from county governments, a change intended to get New York to stop raising Medicaid funds from its counties. 

New York GOP lawmakers argue this will relieve counties from having to pay into Medicaid and lead to property-tax relief for constituents, though the state argues that the move just shifts costs onto it.

Centrist Rep. John Faso (R-N.Y.) said he is now a yes because of the provision, which, he noted, he has been talking to leadership about for two months.

“They were quizzical at first, but I explained,” he said.


Other conservatives

Many conservatives outside of the House Freedom Caucus have been brought on board with new changes.

Leaders of the Republican Study Committee threw in their support after a White House meeting Friday, when they won the ability for states to impose Medicaid work requirements and to choose a block grant of Medicaid funds.

Reps. Tom McClintock (R-Calif.) and Robert Aderholt (R-Ala.) announced their support on Monday night after changes to the bill were announced, including the increased tax credits for older people.

Meanwhile, Pence met with eight of the House’s most prominent anti-abortion lawmakers Monday to tout some of the bill’s abortion restrictions, with Rep. Vicky Hartzler (R-Mo.) committing to support the bill afterward.

Tags David Schweikert Robert Aderholt

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