Top Conservatives Oppose GOP Health Care Plan, Muddying Path to 218

The top two House conservatives on Monday said they cannot vote for their conference’s health care repeal and partial replacement plan in its current form, meaning House GOP leaders have some work to do before they can offer a bill that will get the 218 votes needed to pass the House.

Republican Study Committee Chairman Mark Walker and House Freedom Caucus Chairman Mark Meadows both cited concerns over the plan’s refundable tax credits, saying it amounts to the creation of a new entitlement program. The North Carolina Republicans said that several of their conservative colleagues feel the same way and predicted that the plan could not pass the House in its current form.

No Democrats are expected to join Republicans in voting to repeal the 2010 health care law, so GOP leaders need 218 of their members (out of a current roster of 238 Republicans; soon to be 237 if the Senate confirms Rep. Ryan Zinke as Interior Secretary this week, as expected) to vote for whatever legislation they produce.

Walker said RSC members, who account for roughly two-thirds of the House GOP conference, “would have a tough time” voting for the draft health care plan that was leaked to the press late last week. He said members have not yet been provided with a draft from leadership and that they need more information, specifically what the Medicaid expansion solution would look like long term and how much the refundable tax credits would cost.

“I’m not saying we can’t get there,” he said. “What we don’t want to do is create a fourth column of entitlement when we’re already trying to reform some of the others.”

The leaked draft proposes a refundable tax credit to help individuals who don’t get coverage through an employer purchase a insurance. The amount of the credit would be based on age, rather than income or the cost of available plans, like the credits available through current law. Individuals under age 30 would receive $2,000, individuals between ages 30 and 40 would get a $2,500 credit and individuals over age 60 would get $4,000.

The tax credit proposal put forth in the draft would potentially increase the number of people who use tax subsidies to purchase health insurance, Meadows said.

“It says millionaires can get just as much of a tax credit and a check from the federal government … by putting a tax on union workers and middle class workers that happen to have good employer insurance,” he said, referring to a proposal in the draft that would increase taxes on employer-provided plans. “That dog doesn’t hunt.”

Meadows said “it’s very challenging” to create a refundable tax credit for health insurance that would get 218 votes in the House. “There are ways to fund Health Savings Accounts without making it a reoccurring entitlement,” he said.

While conservatives’ primary opposition is to the tax credits, the draft’s plan to end the current law’s Medicaid expansion in 2020 may concern moderates from states that opted into the expansion.

The draft would allow states to choose whether to continue to fund the expansion while providing less federal money for the effort. Instead of matching federal funds as under current law, states would get a capped payment based in part on the number of people enrolled in the program.

New Jersey Republican Leonard Lance, who was hammered with health care questions at two massive town hall meetings in his district this past week, said he’d like to see the Medicaid expansion preserved in some way but understands that the federal match won’t remain forever.

“The longer the glide path in order to have the budgets at the state capitol adjust, that’s something that I’m sensitive to,” New York Republican Tom Reed said. “And as we do the reimbursement rates for the per capita cap, making sure we look at the unique health care expenses of New York versus a national cap — and that type of thing.”

While neither Lance nor Reed expressed opposition to the draft GOP plan — although neither they nor Walker or Meadows had seen any plan other than the one leaked to the press — their views underscore the complicated nature of addressing a majority of Republicans’ concerns and views in a matter of weeks.

Still, conservatives and moderates alike expressed optimism that a solution could be reached.

“We hope that this spring that we can continue to work hard, [get] together,” Walker said. “We know that everybody is unified in the sense of wanting to do something. To me this is not like black and white. There’s a few things we’ve got to get adjusted. I hope we get there.”

Reed, who serves on the Ways and Means Committee responsible for part of the repeal and replacement, said the next week to two weeks is a “realistic time” frame for Republicans to come together and for legislation to be prepared for committees to mark up.

One of many things standing in the way of that goal is the bill’s cost. Congressional Budget Office estimates have not been released but members said they understand the numbers are still coming back negative.

Meadows said Republicans are still a long way from reaching consensus but hopes they can get to one in time for a floor vote before the end of March. That’s already later than originally planned, he noted, saying that if the timeline slips further, he expects Republican constituents to start getting restless.

-- Erin Mershon contributed to this report.

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