WASHINGTON — President Trump and House Republicans triumphantly announced changes to their Obamacare replacement plan Friday, saying they will pave the way for passing the bill that has earned criticism from many conservative members, as well as Democrats. But some Republicans are still pushing back.
The changes fulfill some requests of more conservative Republicans, but would be optional for states, so as not to alienate moderate members.
Trump said Friday that the leaders of the Republican Study Committee, which contains about 170 House Republicans, now endorse the American Health Care Act.
“All of these noes, these potential noes, are now yesses," said Trump. "Obamacare is dead."
But it’s not clear whether the AHCA now has enough votes to pass the House. House Majority Whip Steve Scalise, who was present at the meeting with Trump, said Friday’s breakthroughs “definitely strengthen our number,” but wouldn’t say if he has a majority.
Members of the far-right Freedom Caucus emerged from a Republican conference meeting Friday clearly frustrated and vowing that there is still enough opposition to bring down the AHCA.
The two amendments to the GOP health care bill, now agreed to by House leadership, the White House and the RSC are:
- Giving the states an option to accept block grant funding for Medicaid — essentially a lump sum payment — rather than the original bill's per-capita funding formula. Currently Medicaid is an open entitlement program to anyone who meets the criteria. Block granting would allow states to place new restrictions on who can get Medicaid.
- The contradictory-sounding "optional mandatory work requirements" for Medicaid. This would give states the freedom, but not obligation, to enact new rules demanding all able-bodied people to be employed in order to receive Medicaid. The bill will include incentives for states to adopt such requirements, but it’s not yet clear what those incentives are.
Freedom Caucus chairman Rep. Mark Meadows dismissed the amendments as mere tweaks and said they do not “move the ball more than a couple yards on a very long playing field.”
Several Freedom Caucus members said Friday they remain opposed to the amended bill.
“They’re buying off people one by one with these little changes," said Rep. Raul Labrador.
"And if people just want little changes to the bill they’re going to be able to be bought. But we’re talking about significant changes," he said, referring to conservative members and the Freedom Caucus.
Labrador said he believes there are still not enough votes in the House for the AHCA to pass.
Other changes are still in the works. One being finalized would beef up the AHCA’s advance refundable tax credits to give more money to low-income seniors. The credits are provided to every American, based on age, to help them buy insurance. Someone in their 20s would receive $2,000 per year while a person over 60 would receive $4,000.
But the Congressional Budget Office projected that these credits do little to offset massive premium increases for lower-income seniors under the new bill. Fixing that could go a long way to appeasing moderates, who seem to have won some key battles in making changes to the bill over hardline conservatives.
Conservatives had denounced the tax credits as a whole as a new social welfare program. They have also pushed for the bill's proposed freeze on Obamacare's Medicaid expansion to be accelerated from 2020 up to 2019 or 2018. Due to strong objection from moderates, that now appears to be off the table.
The Freedom Caucus plans to present its own amendment package on Monday. On Wednesday, the AHCA goes before the House Rules Committee, the final stop before the bill reaches the House floor.
The hope — described as a “pretty hard target” by Rep. Bradley Byrne — is for the AHCA to go to a final House vote on Thursday.