GOP health-care plan: Conservative lawmakers continue to push back on Obamacare replacement


Conservative lawmakers in the House and the Senate continued to attack the Republican health-care plan Tuesday after congressional budget analysts found it would dramatically increase the number of uninsured Americans while raising premium costs in the short term.

The reaction from Republican hard-liners to the Congressional Budget Office report cast doubt on the viability of the American Health Care Act, House Speaker Paul D. Ryan’s proposal to revise Obamacare, which could receive a House vote within two weeks.

Though the bill is projected to lower the federal budget deficit over the next decade and produce a 10 percent average decrease in premiums after that, skeptics on the right remain unconvinced that it would go far enough in pulling back elements of the Affordable Care Act.

“This bill doesn’t repeal Obamacare,” Rep. Jim Jordan (R-Ohio), a member of the House Freedom Caucus, told “Fox & Friends” on Tuesday morning.

“This bill doesn’t unite Republicans. This bill doesn’t bring down the cost of premiums. . . . There’s a reason every major conservative organization in the country is opposed to this legislation.”

The American Health Care Act falls far short of repealing and replacing the Affordable Care Act, but there are some big potential changes.(Daron Taylor/The Washington Post)

Meanwhile, the White House pushed back on a Politico report that its internal analysis on the impact of the AHCA showed an even steeper loss of health insurance than was calculated by the CBO.

“This story is totally misleading,” White House press secretary Sean Spicer tweeted. “The projection was an estimate of what CBO would conclude. It was not a [White House] analysis.”

The CBO report predicted that 24 million fewer people would have health insurance in a decade under the AHCA compared with the current system. According to Politico, the White House analysis found that 26 million more people would go without coverage under the GOP bill.

White House Budget Director Mick Mulvaney said the Office of Management and Budget, which produced the document reviewed by Politico, can’t do coverage estimates.

“I don’t know if the document exists because I haven’t seen it,” he told the host of CNN’s “New Day.” “If it does exist, you just confirmed what I said, which is that we don’t have the ability to do [those estimates] independently at the OMB.”

Mulvaney continued the administration’s assault on the credibility of the CBO, calling its analyses “deeply flawed.”

Referring to the snowstorm hammering the East Coast, he said, “According to the CBO, it’s sunny and 75 degrees this morning.”

What’s next for the Obamacare replacement bill

“This is exactly what we thought the CBO would come forward with,” he said of Monday’s coverage-loss projection. “They’re terrible at counting coverage.”

The White House plans to commence a new round of outreach to skeptical Republican senators on Tuesday. Vice President Pence and Health and Human Services Secretary Tom Price plan to attend Senate Republicans’ weekly policy luncheon, congressional and White House aides said. Price may also meet individually with lawmakers.

Later in the afternoon, members of the Senate Steering Committee, a conservative coalition chaired by Sen. Mike Lee (R-Utah), will meet with President Trump’s team at the White House, the aides said.

Trump will also speak about health care with Ryan and House Majority Leader Kevin McCarthy (R-Calif.) by phone at 4 p.m. Tuesday, the White House schedule stated.

In the Senate, the bill is taking heat from both ends of the political spectrum. Moderate Republicans from states that expanded Medicaid have voiced concerns that the measure does not protect those who obtained coverage through that expansion strongly enough.

“These kinds of estimates are going to cause revisions in the bill, almost certainly,” Sen. Susan Collins (R-Maine) said Tuesday of the CBO report.

“I don’t think that the bill that is being considered now is the bill that ultimately will be the one that we vote on in the Senate.”

On the right, conservatives have complained that the bill is not a forceful enough repeal of the Obama administration’s health-care law.

Lee, along with Sens. Rand Paul (R-Ky.) and Ted Cruz (R-Tex.), has been the chief conservative critic of the law, urging GOP leaders to do more.

“There is a solution for House Leaders that conservatives have offered: abandon Obamacare Lite now,” Paul wrote Tuesday on Twitter.

“It is bad law & it can’t pass. If House leaders try do a little less using the same basic framework as the failed Obamacare experiment, then it will fail too.”

That opposition, along with growing Senate Republican calls for the House to slow its pace of advancing the legislation though its chamber, has left significant uncertainty about whether the bill can even pass the upper chamber, should it advance from the House. A growing number of Republicans believe it will have to undergo significant changes in one or both chambers to survive.

Sen. Bill Cassidy (R-La.), a physician and strong Affordable Care Act critic, sounded apprehensive about the CBO report’s implications.

“President Trump said that he wants as many people covered as under Obamacare,” Cassidy said Monday. “He said that health care should be affordable. If there’s 14 million people losing insurance, of course it’s concerning. I try to avoid hyperbole and adjectives, but it’s concerning.”

Sen. Tom Cotton (R-Ark.) again urged House leaders to “pause” and take seriously the CBO’s projections on coverage and premiums.

“They’re right that coverage levels will go down in the coming years under the House bill,” Cotton said of the CBO during an interview with conservative radio host Hugh Hewitt on Tuesday morning.

“They’re also right, I’m afraid, that insurance premiums will continue to go up in the near term, for three to four years, before they start perhaps falling in the long term.”

Cotton added that GOP critics of the bill “come from all stripes.”

“They’re not just hard-line conservatives. Many of them are centrists, or many of them are just being practical-minded about this bill, the way I am. Just from a practical standpoint, I don’t think this bill is going to reduce premiums for working Americans. I think it’s going to cost coverage for many Americans as the CBO said yesterday,” Cotton said.

One of those GOP skeptics, Rep. Rob Wittman (Va.), announced Monday that he would oppose the bill.

“I do believe that we can enact meaningful health care reforms that put the patient and health care provider back at the center of our health care system, but this bill is not the right answer,” he wrote in a Facebook post.

Wittman’s stance could represent a new front of House Republican dissent. A six-term member who leads a House Armed Services subcommittee and represents a district that favored Trump by 12 percentage points, Wittman is neither a hard-right firebrand nor a wary moderate from a Medicaid expansion state. Rather, he is the sort of mainstream conservative that Ryan is counting on to toe the party line and pass the bill.

Ryan (R-Wis.), meanwhile, said in a Fox News interview Monday that the report “exceeded” his expectations, and he jumped on its prediction of a smaller deficit to try to assuage conservatives, many of whom oppose the idea of new tax credits to help some Americans buy coverage on their own.

Declaring that the plans would usher in “the most fundamental entitlement reform in a generation,” Ryan said the legislation “is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows.”

McCarthy sought to further this argument on Tuesday, telling Fox News that the AHCA is only one piece of a three-step reform process.

“Remember, the CBO can only score what’s in front of them. This is one of three phases. So they’re not even able to look at what the second and third phase does,” McCarthy said.

Cotton rejected this reasoning in his interview with Hewitt.

“There is no three-phase process,” he said. “There is no three-step plan. That is just political talk. It’s just politicians engaging in spin. . . . There is not going to be phase three legislation. It’s phase one and done.”

Nevertheless, a group closely aligned with House Republican leaders hit the airwaves Tuesday with a new round of television ads defending 15 House GOP lawmakers for moving to overhaul the ACA, a $1.5 million investment that coincides with the release of the CBO forecast and reflects the potential political vulnerability of House Republicans.

The American Action Network is running 30-second advertisements asking viewers to “thank” the GOP lawmakers for living up to their promise of “replacing the Affordable Care Act with the better health care you deserve.” The ads do not use the word “repeal,” even though the GOP has long used that language in campaign rhetoric and the House bill would repeal key parts of the ACA.

House Republicans’ proposal to rewrite federal health-care law would more than reverse the gains the ACA has made in the number of Americans with health coverage and nearly double the share of uninsured people from 10 percent to 19 percent in 10 years, the CBO found. The number of uninsured people would jump 14 million after the first year alone.

Premiums would be 15 to 20 percent higher in the first year compared with under the ACA but 10 percent lower on average after 2026, the report stated. By and large, older Americans would pay “substantially” more and younger Americans less.

The 37-page report provided the most tangible evidence to date of the human and fiscal impact of the House GOP plan and called into question Trump’s pledge that no Americans would lose coverage when it came time to replace Obamacare.

On Tuesday, Democratic leaders Nancy Pelosi and Charles E. Schumer joined Doctors for America, a pro-ACA group that grew out of the 2008 Obama campaign, for a news conference with voters who would lose coverage under the GOP plan.

“Stress is the last thing anyone needs when they are sick, and this bill is causing people a lot of stress,” said Pelosi, who called the proposal a “reverse Robin Hood stunt.”

“They’re saving $33 billion a year and they’re cutting off 26 million people from health care,” she said. “It’s just not a good investment. . . . They should just pull the plug on this bill.”

Schumer lit into Republicans for questioning the CBO’s estimate, pointing out that the CBO’s director, Keith Hall, was plucked out of the right-leaning Mercatus Center and praised by the GOP up until it was clear that the AHCA would get an unfavorable score.

“The only winners in this CBO report are health insurance executives and the wealthiest Americans,” Schumer said. “It’s classic Trump: Talks like a populist, but when he acts, it’s hard right.”

Abby Phillip, Sean Sullivan and David Weigel contributed to this report.



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