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    GOP leaders tweak health bill as conservatives repeat opposition

    House Speaker Paul Ryan spoke about the American Health Care Act with other Republican leaders last week.
    Gabriella Demczuk/The New York Times/File
    House Speaker Paul Ryan spoke about the American Health Care Act with other Republican leaders last week.

    Republican leaders trying to gain party support for their bill to replace Obamacare made changes to limit Medicaid enrollment and phase out some taxes earlier, but 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.

    The alterations are being proposed to help add Republican support for the bill, which is set to come up for a vote on the House floor Thursday. The changes include an option to allow states to require people covered by Medicaid to work and a provision prohibiting extra funding to states that newly expand Medicaid. 


    President Donald Trump is planning to meet Tuesday morning with Republicans in an effort to shore up votes for the overhaul, called the American Health Care Act, two congressional aides said.

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    “This is our long-awaited chance to finally get rid of Obamacare,” Trump told a rally in Kentucky Monday night. “Thursday is our chance to end Obamacare and the Obamacare catastrophe and to begin delivering the reforms our people deserve.”

    ‘One Step Closer’

    House leaders praised the changes Monday night, with House Speaker Paul Ryan saying Republicans were “one step closer” to repealing Obamacare.

    “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,” he said in a statement late Monday.

    But members had different opinions on whether the changes would be enough to get it through.


    “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.

    ‘Defining Moment’

    “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.”

    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.

    ‘A Whip That’s 10 Feet Long’

    “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.

    An outcry followed the introduction of the GOP bill, which would cut assistance for people buying insurance, roll back the Medicaid program for the poor and lead 24 million more Americans to be uninsured in 2026 than under Obamacare, according to one analysis. Swelling numbers of people unable to pay their medical bills would take billions of dollars out of the health-care system, pressuring hospitals, insurers and other health-care companies.

    House leaders expect an updated analysis of the bill from the nonpartisan Congressional Budget Office before lawmakers vote on it, Ways and Means Chairman Kevin Brady told reporters Monday.

    Ryan and his GOP lieutenants can afford to lose no more than 21 votes in the chamber, presuming all Democrats vote against the bill.

    Medicaid Tweaks

    The changes to the bill give states another option for how their Medicaid payments from the federal government would be calculated. States could opt for block grant payments, instead of the per-person payment caps that were already in the measure. The so-called manager’s amendment would also repeal Obamacare’s taxes this year, one year earlier than originally planned.

    Representative Chris Collins, a New York Republican, also told reporters Monday that leaders agreed to add a special provision to hold $2.3 billion a year in Medicaid funding from New York unless the state’s governor and state legislature agree to stop forcing counties to help pay for Medicaid. He said the change was needed to help persuade most New York Republicans in the House to back the measure.

    The Medicaid provision is written to pertain only to New York counties outside of New York City, said Representative John Faso, a co-author.

    The changes didn’t include an alteration some conservative GOP members sought to wind down Obamacare’s expansion of Medicaid starting in 2018 rather than in 2020 as was proposed in the original legislation. 

    Some moderate Republicans also wanted to increase tax credits for older, poorer people -- a demographic that would pay substantially more for health coverage under the GOP bill than under Obamacare. Those changes weren’t made in the most recent version, but part of the amendment leaves room for the Senate to increase the tax credits for that group.

    The Medicaid limits are an appeal to more conservative Republicans. Most members of the Freedom Caucus want to go further and make it mandatory in all states, a GOP aide said.

    The caucus would also like to repeal insurance regulations instituted under the Affordable Care Act, often called Obamacare, that for example, require health plans to cover services known as essential health benefits, such as hospitalizations, prescription drugs and mental health services.