GOP May Again Change Health Care Proposal As They Seek Votes

Speaker Paul Ryan, R-Wis., conducts a news conference with members the GOP caucus in the Capitol Visitor Center to announce a new amendment to the health care bill to repeal and replace the ACA, April 6, 2017. (Tom Williams/CQ Roll Call)


House Republicans still hope to vote on their health care overhaul next week, though lawmakers said Friday they may need further changes to scrape together enough votes to pass it.

Rep. Tom MacArthur of New Jersey, who authored an amendment that won the support of hardline conservatives earlier in the week, acknowledged Friday that Republicans are discussing changes to his language. He declined to specify what those changes might include.

“I’m open to any good idea that gets us across the line,” he said.

Several lawmakers are seeking policy changes that could persuade a few holdouts to support the bill, Republicans said. But Energy and Commerce Chairman Greg Walden confirmed his committee is not examining those changes yet. House Freedom Caucus Chairman Mark Meadows of North Carolina, who was involved in negotiations, said he hasn’t been asked to review any additional language.

Any tweaks at this point are aimed at moderate members, who are still withholding their support for the legislation. As of noon Friday, at least 19 Republicans — more than a dozen of whom are members of the moderate Tuesday Group — have said they will oppose the legislation if it comes to the floor. Still others, including members who supported the previous version, such as Reps. Fred Upton of Michigan, are now undecided. Upton said explicitly he “doesn’t like” the MacArthur amendment.

“I thought we were further along than we were,” Rep. Pat Tiberi of Ohio, who is chairman of the Ways and Means Health Subcommittee, said Friday.

Republican leaders can afford to lose just 22 of their 238 members on the legislation, though that number could shift depending on who is absent the day they vote. Meadows acknowledged there were no more conservative votes he could deliver. 

Republicans are working hard on the bill because they have pledged for years to repeal the 2010 health care law. President Donald Trump also campaigned on a promise to repeal that law.

The whip operation has been in full swing this week with a series of late-night leadership meetings and a host of individual member discussions on the House floor and elsewhere, lawmakers said.

“They’re going through them one by one,” Rep. Tom Reed of New York said. “They’re really trying to address member by member type of issues, if they can.”

Changes aimed at winning over moderates, however, risk alienating the hardline conservative bloc that only just announced its support this week. The dynamic is a repeat of the conference politics that have bedeviled Speaker Paul D. Ryan of Wisconsin on every effort to finalize the health care legislation this year. The same back-and-forth led to the GOP’s embarrassing failure on health care in March, when Ryan pulled legislation from floor consideration because it lacked the votes to pass.

Despite those dynamics, many members said the reinvigorated process that MacArthur’s amendment kicked off has not yet collapsed.

Reps. Chris Collins, Energy and Commerce Health Subcommittee Chairman Michael C. Burgess of Texas, Reed, Tiberi, and Meadows all said Republicans have made progress and the vote could happen as soon as next week. None committed to that specific timeline, though. 

“They’re talking even right now with the individual members, and it’s a handful of votes, to get us over the finish line,” Collins said. “No one’s going to put an artificial deadline on it.”

Walden said he believed that a vote next week was likely but said he didn’t want to impose a deadline. While he was told leadership was “close” to having the needed votes, he said the whip count has not been shared with him, noting only a handful of people are privy to whip counts. 

“I don’t think it has to be voted on next week. I certainly would be extremely disappointed if it didn’t,” Meadows said.

Search for Plan B

Meadows said he is also working on two other health care proposals to lower health insurance premiums that could be advanced if the current package doesn’t ever get a vote.

“We’re going to vote on something. It’s either this or it’ll be a backup Plan B or Plan C,” he said.

Meadows gave a broad outline of what the proposals include, referring to policies to make the health insurance “tax credits more accessible to those below 400 percent of poverty” and to ensure the credits are “obviously lowering premiums, the net premiums that people pay.” He also suggested a policy that would center on a state-based high risk pool to “lower premiums even more than what we have proposed.”

Meadows declined to say who was involved in working on it, and said the idea is not yet written in legislative text. He also emphasized that this is not his first preference. He still wants to pass the proposal that includes the MacArthur amendment.

“I’m all in for this particular bill, with these particular amendments, to try to get it across the finish line,” he said.

Kerry Young, Andrew Siddons and Sandhya Raman also contributed to this report.

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