Ahead Of Critical Vote GOP Unveils More Changes To Health Bill, But It's Not Enough

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With just two days left until the House is set to vote this Thursday on the critical Obamacare repeal bill, where an adverse vote could lead to the biggest blow to Trump’s domestic policy agenda yet, House Republican leaders on Monday night released the latest set of changes to their ObamaCare replacement bill, as they scrambled to win more votes for the legislation. 

According to the Hill, the changes include two measures that conservative Republican Study Committee members won at the White House on Friday: allowing states to require Medicaid recipients to work and allowing states to choose a Medicaid block grant over the cap system in the current bill.  The House changes – which come in the form of a manager’s amendment –  also contain nods to calls from lawmakers to increase tax credits for older people to address projected cost spikes under the GOP bill, without actually making that change. Instead, the House bill would enact a different, placeholder provision to increase a medical tax deduction, with roughly the same cost, $85 billion over 10 years.  

As summarized by Axios, the GOP leaders skipped some of the biggest changes they could have made instead punting on the key ; a list of the actual changes the House GOP is making is as follows:

  • States can now choose Medicaid per capita caps or block grants.
  • There will be an optional Medicaid work requirement (with extra federal funds for states that do it).
  • There will be a more generous Medicaid inflation adjustment for the costs of elderly and disabled.
  • Obamacare taxes get repealed a year earlier.

What they punted on:

  • A reserve fund to beef up the tax credit, especially for the low-income elderly, but no actual change to the tax credit. That’s up to the Senate.

What they left out:

  • It doesn’t end the Medicaid expansion earlier, as conservatives wanted. Rep. Joe Barton could still bring that to the Rules Committee on Wednesday.
  • It doesn’t try to repeal Obamacare’s insurance regulations. GOP leaders say that can’t be done in a budget “reconciliation” bill, but conservatives want them to try.

Still, the overall structure of the bill remains the same after these changes which is why the head of a House conservative group said there still aren’t enough votes to pass the measure

“Currently there are not enough votes to pass the legislation,” House Freedom Caucus Chairman Mark Meadows said Monday night after a raucous caucus meeting. The group, which has opposed earlier versions, didn’t take an official position on the changes, but a spokeswoman said a whip count by the group showed it could block passage. Meadows added that “our leadership is going to put forth a bill that does not address any of the concerns in a meaningful way and will dare us to vote against it.”  The Hill also adds that it remains in doubt whether this range of changes will be enough to win the 216 votes needed for the bill to pass on Thursday. 

But the House chairmen who helped lead the efforts to write the bill, known as the American Health Care Act, expressed confidence.

“We’re confident these changes will set AHCA up for success in the House,” Chairmen Kevin Brady and Greg Walden said in a statement. “We look forward to working with our Senate colleagues to get this bill over the finish line and send it to the President as quickly as possible.”

House Speaker Paul Ryan was also optimistic “With this amendment, we accelerate tax relief, give states additional options to spend health care dollars how they choose, strengthen what were already substantial pro-life protections, and ensure there are necessary resources to help older Americans and the disabled.” In a statement late on Monday he also said: “I want to thank the White House and members from all parts of our conference who have helped make this the strongest legislation it can be.”

“With the president’s leadership and support for this historic legislation, we are now one step closer to keeping our promise to the American people and ending the Obamacare nightmare.”

The optimism was quickly shut down by theMeadows: “I think there are obviously some small tweaks that are good tweaks but there’s no substantial changes in the manager’s amendment that would make anybody be more compelled to vote for this,” Meadows said.

“This is a defining moment for the Freedom Caucus,” he added. “I don’t think there is a more critical vote for the Freedom Caucus than this particular one.” Another Freedom Caucus member, Justin Amash of Michigan, said he’s confident the group will largely hold together to block the bill after leaders ignored their demands.

“We’ve made suggestions all the way through,” he said Monday night. “If they don’t want to listen to them then that’s on them.”

On Tuesday morning, the president will visit Capitol Hill in an attempt to seal House Republican support for the plan. Representative Phil Roe, a member of the Republican vote-counting team, said Trump’s visit may help “any wavering souls.” “It’s gonna be a close vote I think, but I think it’s going to pass,” said Roe.

House leaders were working hard to to win over remaining holdouts, both
conservatives and moderates in their party, a process known as whipping
votes. “They’re already whipping with a whip that’s 10 feet long and five feet wide,” Meadows said when asked if GOP leaders were trying to pick off individual members of the Freedom Caucus.

Finally, as Axios concludes, this means “we will still have lots of drama between now and Thursday night.”