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House Budget Committee Endorses Health Care Repeal Bill Trump and G.O.P. Work to Win Repeal of Obama’s Health Act
(about 7 hours later)
WASHINGTON — House Republicans on Thursday powered through another step toward repealing the Affordable Care Act as the Budget Committee approved the House’s embattled repeal bill over the opposition of three conservative Republicans on the panel. WASHINGTON — President Trump and House Republican leaders worked Thursday to win conservative support for legislation to repeal the Affordable Care Act, offering concessions to speed cutbacks in Medicaid and dismantle more of President Barack Obama’s signature health law.
By a vote of 19 to 17, the committee endorsed the legislation and sent it to the full House, where Republican leaders hope to bring it up later this month. But the defection of three Republicans — Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina — showed the difficult road ahead. But in a bid to ensure passage of the Republican health care bill in the House, White House and Republican leaders risked losing support in more moderate quarters of their party — not only in the narrowly divided Senate, but in an increasingly nervous House.
A faster path to Medicaid cuts, new work requirements for Medicaid recipients and potentially smaller tax credits for the working poor could mollify conservatives who are pressing for a smaller government footprint on the health care system, but they would cut deeper into the benefits that many Trump voters have enjoyed under the Affordable Care Act.
White House officials have made clear that they are open to supporting amendments that would require a quicker end to the expansion of Medicaid under the 2010 health care law, according to an administration official involved in negotiations with Congress.
Representative Joe L. Barton, Republican of Texas, and other conservatives want to freeze the expansion of Medicaid next year, two years earlier than under the legislation drafted by House Republican leaders. Referring to this change, Mr. Barton said, “The Trump administration is open to it.”
But in an interview, Representative Leonard Lance, Republican of New Jersey, said: “I am opposed to that. New Jersey expanded Medicaid. I don’t want that to be eliminated.” The federal government pays at least 90 percent of Medicaid costs for newly eligible beneficiaries, and Mr. Lance said, “I would like that to continue for at least several years.”
Mr. Ryan said Mr. Trump was now fully engaged.
“This president is getting deeply involved,” Mr. Ryan said. “He is helping bridge gaps in our conference. He is a constructive force to help us get to a resolution.”
The political stakes for the president and the speaker could hardly be higher. If they succeed in undoing the Affordable Care Act, it would add momentum to efforts to enact other items on their agenda, such as tax cuts and a rewrite of the tax code. If they fail, it would embolden Democrats keen to block Mr. Trump — and conservatives still seeking to imprint their hard-line policies.
But they are in a delicate dance with conservatives and moderates. Halting the expansion of Medicaid in 2018, rather than 2020, “would be a huge problem, enormously problematic,” said Representative Charlie Dent, Republican of Pennsylvania, one of 31 states that have expanded eligibility for Medicaid under the Affordable Care Act.
House Republicans appeared determined to power through, despite divisions in their ranks. On Thursday, the House Budget Committee approved a motion to send the repeal bill to the full House, where Republican leaders plan to take it up later this month.
But the 19-to-17 vote in the Budget Committee portends possible difficulties. Three conservative Republicans — Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina — voted no, joining a united Democratic opposition.
“This legislation is a conservative vision for free-market, patient-centered health care,” said Representative Diane Black of Tennessee, the chairwoman of the Budget Committee. “It dismantles Obamacare’s mandates and taxes. It puts health care decisions back in the hands of patients and doctors.”“This legislation is a conservative vision for free-market, patient-centered health care,” said Representative Diane Black of Tennessee, the chairwoman of the Budget Committee. “It dismantles Obamacare’s mandates and taxes. It puts health care decisions back in the hands of patients and doctors.”
House Republican leaders acknowledged that they did not yet have the votes to ensure that the bill would be passed. To appease House conservatives, the White House is looking at accelerating cuts to Medicaid, which would not begin until 2020 in the current bill, according to a person briefed on the discussions, aiming to move the bill through the House and daring moderate Senate Republicans to stand in its way. President Trump, the person added, could take to the road himself to pressure potentially reticent members in states he won by a large margin. The Budget Committee endorsed a Republican proposal suggesting that the bill could be improved by imposing work requirements on certain Medicaid beneficiaries — able-bodied adults without minor children. Representative Glenn Grothman, Republican of Wisconsin, said that Medicaid in its current form was “a seductive entitlement” that encourages people “not to work at all, or to work less.”
But that would make the outlook in the Senate even more cloudy. That change would have to be made later in the legislative process; the committee approved a motion directing Ms. Black to seek an amendment authorizing work requirements.
Last week, Speaker Paul D. Ryan appeared to reject major changes sought by conservatives, saying, “It really comes down to a binary choice” between the repeal bill and nothing. Republican leaders acknowledged that they did not yet have the votes to ensure that the full House would pass the repeal bill, but Mr. Ryan said he was “working hand in glove” with Mr. Trump to achieve that goal.
But on Wednesday, after a meeting of the House Republican Conference where Vice President Mike Pence tried to rally support for the legislation, Mr. Ryan opened the door to changes, saying, “We can make some necessary improvements and refinements to the bill.” Mr. Trump “knows how to connect directly with people,” Mr. Ryan said
Mr. Ryan promised to incorporate suggestions from lawmakers and the Trump administration. “Conversations are occurring between the White House, the House, and the Senate and our members,” he said. House passage, Mr. Trump’s aides believe, would force the Senate Republican holdouts to consider whether they would be willing to vote against repeal of a law they have been pledging to undo for seven years.
To make opposition even harder for Senate Republicans, Mr. Trump’s aides plan to deploy him to states he won where Republican senators may be uneasy about the current legislation.
With no hope of winning support from Democrats, Ms. Black appealed to members of her party.With no hope of winning support from Democrats, Ms. Black appealed to members of her party.
“To my Republican colleagues who have doubts,” Ms. Black said, “I encourage you: Don’t cut off discussion. Stay in this effort and help us enhance this proposal by advancing it out of committee and pushing for further conservative reforms. Members who desire to see this bill improved have every right to make their voices heard.”“To my Republican colleagues who have doubts,” Ms. Black said, “I encourage you: Don’t cut off discussion. Stay in this effort and help us enhance this proposal by advancing it out of committee and pushing for further conservative reforms. Members who desire to see this bill improved have every right to make their voices heard.”
But Representative John Yarmuth of Kentucky, the senior Democrat on the Budget Committee, said: “This is not a health care bill. It’s an ideological document, a fantasy about freedom and choice.” Last week, Mr. Ryan appeared to reject major changes sought by conservatives, saying, “It really comes down to a binary choice” between the repeal bill and that status quo.
The bill would eliminate penalties for people who go without insurance and create a new system of tax credits to help people buy private insurance. It would roll back the expansion of Medicaid authorized by the Affordable Care Act and give each state a fixed allotment of federal money to provide health care to low-income people on Medicaid. But on Wednesday, after a meeting of the House Republican Conference where Vice President Mike Pence tried to rally support for the legislation, Mr. Ryan opened the door to changes, saying, “We can make some necessary improvements and refinements to the bill.”
Beyond the faster end to the Medicaid expansion, conservatives want to establish work requirements for some Medicaid beneficiaries. Some conservatives are still pressing to limit the size of the tax credit for the purchase of insurance to no more than the amount of federal income taxes a recipient owes. That would further hurt low-income consumers who may owe little or no income taxes, and under the current proposal would get a check from the Internal Revenue Service to offset insurance costs. The bill would eliminate tax penalties for people who go without insurance and create a new system of tax credits to help people buy private insurance. It would roll back the expansion of Medicaid authorized by the Affordable Care Act and give each state a fixed allotment of federal money to provide health care to low-income people on Medicaid.
Democrats on the Budget Committee found support for their case in a report issued this week by the nonpartisan Congressional Budget Office. The report estimated that the House Republican bill would increase the number of people without insurance by 14 million next year and by 21 million in 2020. “In just three years,” Mr. Yarmuth said, “the entire gains under the Affordable Care Act will be wiped out.” Beyond the faster end to the Medicaid expansion and work requirements for some Medicaid beneficiaries, some conservatives are still pressing to limit the size of the tax credit for the purchase of insurance to no more than the amount of federal income taxes a recipient owes. That would further hurt low-income consumers who may owe little or nothing in income taxes, and under the current proposal would receive financial assistance from the government to help offset insurance costs.
Some 20 million uninsured people have gained coverage under the law, which was signed by President Barack Obama seven years ago. Democrats on the Budget Committee found support for their case in a report issued this week by the nonpartisan Congressional Budget Office. The report estimated that the House Republican bill would increase the number of people without insurance by 14 million next year and by 21 million in 2020. “In just three years,” said Representative John Yarmuth of Kentucky, the ranking Democrat on the Budget Committee, “the entire gains under the Affordable Care Act will be wiped out.”
Some 20 million uninsured people have gained coverage under the law, which was signed by Mr. Obama seven years ago.
Representative Sheila Jackson Lee, Democrat of Texas, said: “This is a bust-Medicaid bill. It is not a health care bill.”Representative Sheila Jackson Lee, Democrat of Texas, said: “This is a bust-Medicaid bill. It is not a health care bill.”
Representative John J. Faso, Republican of New York, had previously raised questions about a provision of the bill that would cut off federal funds for Planned Parenthood clinics. But on Thursday he said the overall bill was needed to protect people against potential harm from the health law. Representative John J. Faso, Republican of New York, had previously raised questions about a provision of the bill that would cut off federal funds for Planned Parenthood clinics.
“Many people across the country are happy with the Affordable Care Act,” Mr. Faso said. “But just as many, if not more, are seeing extraordinary increases in premiums, extraordinary increases in deductibles. They can no longer afford it.” But on Thursday he said the overall bill was needed to protect people against potential harm from the health law. “Many people across the country are happy with the Affordable Care Act,” Mr. Faso said. “But just as many, if not more, are seeing extraordinary increases in premiums, extraordinary increases in deductibles. They can no longer afford it.”
“We’ve got to fix the mess that the Affordable Care Act has created in health insurance markets,” he added.
Republicans said the bill took a big step toward one of their longstanding policy goals: equalizing the tax treatment of health coverage provided by employers and insurance purchased by individuals and families in their own.