Republicans change health bill in a bid to sway members

House Speaker Paul Ryan spoke about the American Health Care Act at a news conference earlier this month.
J. Scott Applewhite/AP
House Speaker Paul Ryan spoke about the American Health Care Act at a news conference earlier this month.

WASHINGTON — House Republican leaders, racing toward a planned Thursday vote on their proposed health care overhaul, unveiled changes to the legislation late Monday that they believe will win over enough members to secure its passage.

The changes addressed numerous GOP concerns about the legislation, ranging from the flexibility it would give states to administer their Medicaid programs to the amount of aid it would offer older Americans to buy insurance. They are the product of two weeks of negotiations that stretched from the Capitol to the White House to President Trump’s Florida resort.

The bill’s proponents also appeared to overcome a major obstacle Monday after a key group of hard-line conservatives declined to take a formal position against the bill, known as the American Health Care Act.


The House Freedom Caucus has threatened for weeks to tank the legislation drafted by Speaker Paul D. Ryan, arguing that it does not do enough to undo the seven-year-old Affordable Care Act. If the group of roughly three dozen hard-right GOP members uniformly opposed the bill, it could block its passage. Their neutrality gives the legislation a better chance of passage when the bill is expected to hit the House floor this week.

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Representative Mark Meadows of North Carolina, the chairman of the caucus, said Monday that while most members of the group remained opposed to the bill, they would not choose to require members to oppose the bill on the floor. That frees House leaders and White House officials to persuade individual Freedom Caucus members to support the measure — a process that Meadows acknowledged was already underway.

“They’re already whipping with a whip that’s about 10 feet long and five feet wide,” he said. “I’m trying to let my members vote the way that their constituents would want them to vote. . . . I think they’re all very aware of the political advantages and disadvantages.”

House leaders hope to pass the bill Thursday and then send it to the Senate. Trump himself is expected to press for the bill’s passage in a Tuesday morning meeting with Republican lawmakers.

Some of the changes unveiled Monday were made to placate conservatives, such as accelerating the expiration of the Affordable Care Act’s taxes and further restricting the federal Medicaid program. But a major push was made to win moderate votes, including a maneuver that House leaders said would allow the Senate to beef up tax credits for older Americans who could see major increases in premiums under the GOP plan.


There were signs Monday that the bill had growing support among the moderate wing of the House GOP. Representative Tom MacArthur of New Jersey, who had voted against the leadership in an early procedural vote on the health care legislation, said that he was “satisfied enough that I will support the bill.”

MacArthur said he was assured that the bill would do more for older and disabled Americans covered under Medicaid and that an additional $85 billion in aid would be directed to those between ages 50 and 65. “That’s a $150 billion change in this bill to help the poor and those who are up in years,” he said.

Several House Republicans from upstate New York won an amendment that would allow counties in their state to keep hundreds of millions of dollars of local tax revenue that they now forward to the state government to fund its Medicaid program. One member, Representative Claudia Tenney, told the Syracuse Post-Standard on Monday that her support of the bill was conditioned on the amendment’s inclusion.

Opponents of the bill — Republicans and Democrats alike — called the deal a sordid giveaway on social media networks Monday night. Many compared it to the state-specific deals that were cut to pass the Affordable Care Act in 2009 and 2010 and panned by Republicans — such as the Medicaid reimbursement boost that then-Senator Ben Nelson of Nebraska secured for his home state that Republicans mocked as the “Cornhusker Kickback.”

The changes were unveiled as Trump held a rally in Kentucky, where he cited cited Senator Rand Paul, one of the Republicans in Congress who have been vocally resisting the House plan.


‘‘I happen to like, a lot, Senator Rand Paul. I do,’’ Trump told the crowd. ‘‘I look forward to working with him so we can get this bill passed in some form, so that we can pass massive tax reform, which we can’t do until this happens.’’

Earlier in his speech, Trump made a similar pitch on trade deals, arguing that health care needs to be cleared from the agenda before he can start renegotiating deals he said have put the United States at a disadvantage.

‘‘As soon we get the health care finished, I'm looking forward to these trade deals,’’ Trump said, later adding: ‘‘We’re going to do something with NAFTA you’re going to be very impressed with.’’

In a separate development, The New York Times reported that the current health bill includes a provision that would bar federal financial assistance for many people — who now receive it under the Obama health care program — on grounds that the health insurance plans include coverage for abortion.