House conservatives have outlined changes they’d like to see in the health care measure currently moving through the chamber, including an accelerated freeze of Medicaid expansion enrollment and at least a partial reduction in the refundable portion of the tax credits proposed to help individuals buy health insurance.
Republican Study Committee Chairman Mark Walker said his group is asking for the enrollment freeze for the Medicaid expansion program to begin sometime in the current 115th Congress. The bill currently proposes that the enrollment freeze begin in 2020, halfway through the 116th Congress.
“We feel like if we don’t, future Congresses may not be able to put the expansion in a way and a place that we feel like … it needs to go,” the North Carolina Republican said.
“The other component of that is all of our data shows that if you’re able to pull people out of poverty, that if you’re really serious about upward mobility, that you want to be able to have a place for people to be able to transition off,” he added.
Walker’s comments came after the RSC’s weekly meeting in which Mary C. Mayhew, Maine’s Health and Human Services commissioner, spoke about how her state has been able to reduce some of its Medicaid expansion.
Mayhew, who was invited to the meeting by RSC member Bruce Poliquin of Maine, described “how it’s really changed the economic culture of their entire state,” Walker said.
“As opposed to just talking about it, having somebody here who actually has done it makes a big difference,” he said.
According to a document being circulated among House conservatives outlining ideas for improvements to the health care bill, members are also looking for an earlier reduction in the federal share of Medicaid costs due to the expansion.
The document mentions reducing the federal share beginning in 2017 or 2018 for either all recipients or new enrollees to “start the downward slope for Medicaid expansion this Congress, and lessen the chances that a future Congress would face a cliff and refuse to allow the expansion to end.”
House Freedom Caucus board member Scott Perry on Wednesday also called for an earlier stop to Medicaid expansion enrollment amid concerns about continuing the federal matching funds at the same level as current law.
“I just think that’s an inducement and I think it hurts people that want to go get a job but can’t leave Medicaid because they’re worried about losing that benefit,” the Pennsylvania Republican said.
In addition to issues with the Medicaid expansion portion of the bill, conservatives are still concerned about the long-term impact of using refundable tax credits to subsidize insurance, Walker said. He added that the measure’s inclusion of income caps on those credits was a move in the right direction.
“It’s got the characteristic of an entitlement long-term and that is a concern for many of our members,” he said. The House Freedom Caucus has also said the refundable credits amount to the creation of an entitlement.
One idea for improving the structure of the credit is making it only partially refundable and eventually tying the credit to a work component so as not to disincentivize individuals from seeking employment, Walker said.
The document circulating among conservatives mentions that idea, as well as a proposal to eliminate the refundable portion of the credit altogether.
Walker was among the House members who met with Vice President Mike Pence and Health and Human Services Secretary Tom Price on Tuesday.
The RSC steering committee also met Tuesday night with Office of Management and Budget Director Mick Mulvaney and Ways and Means Chairman Kevin Brady, who is a member and former chairman of the RSC. Walker said it was a positive meeting, “especially when we heard that this was still part of a process.”
Walker and Perry both expressed optimism that leadership would listen to conservative ideas. Maryland Republican Andy Harris, a Freedom Caucus and RSC member, said he’s undecided on the bill in its current form but noted that conservatives in general are looking for some improvements to get to yes.
“I think if there are no changes made, I just don’t think they have the votes to pass it,” Harris said.
They might get an assist from President Donald Trump.
A top conservative activist emerged from a White House meeting with the president and said Trump is pressing for changes to the GOP measure.
“He heard our concerns, our very serious concerns with the House draft bill,” David McIntosh, president of the Club for Growth, told reporters outside the West Wing on Wednesday evening. “I’m encouraged that the president indicated they’re pushing to make changes in the bill.”
“They’ve heard us that the bill as it stands now has serious problems,” he said. “But I’m encouraged that the president indicated they’re working to make it better.”
A White House official said Wednesday evening that the president would “continue working with Congress to ensure we have a health care system that benefits all Americans.”
John T. Bennett contributed to this report.