Republicans cleared a path Thursday for their Obamacare replacement to reach the House floor, narrowly approving a package in the Budget Committee that can overcome Democratic opposition later on, though the vote exposed a GOP rift that could sink the effort from within President Trump’s own party.
Reps. Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina joined every Democrat in opposing the package during the 19-17 vote, making them the first Republican lawmakers to formally dissent to the plan after it cleared a pair of committees last week.
Republicans have been reeling after the Congressional Budget Office estimated the plan would save $300 billion but result in 24 million fewer people holding insurance a decade from now — spooking centrist members while making conservatives even more certain that the plan amounts to an expensive entitlement.
Mr. Brat, Mr. Palmer and Mr. Sanford are members of the House Freedom Caucus, a vocal group that has blasted leadership’s health plan as a new entitlement that doesn’t go far enough in outright repealing the Affordable Care Act and slashing premiums.
Rep. Mark Meadows, North Carolina Republican who chairs the vocal caucus, said late Wednesday he’d counted enough dissenting votes to block the GOP package in its current form, though any effort to assuage their concerns would alienate moderates who say the plan is already too draconian.
Budget Committee Chairman Diane Black implored conservatives to stick with the plan, saying it would empower states, cut taxes while reducing deficits and cut premiums by an estimated 10 percent by 2026.
“Don’t cut off the discussion,” the Tennessee Republican said.
The main purpose of the markup was to fuse two bills from the Energy and Commerce and Ways and Means committees into legislation that can pass on majority votes under an arcane process known as budget reconciliation.
The Budget Committee could make non-binding recommendations, but not major changes. The true wrangling will begin when the package lands in the House Rules Committee, which controls the terms of debate and potential changes to legislation hitting the floor.
House Speaker Paul D. Ryan said he is open to refinements, but not sweeping changes to the bill endorsed by Mr. Trump.
As written, the plan repeals most of Obamacare’s taxes and its unpopular mandate requiring people to hold insurance. It replaces Obamacare’s subsidies with refundable, age-based tax credits, while allowing insurers to charge older Americans up to five times what they charge young people, compared to Obamacare’s three-to-one ratio.
It also freezes the vast expansion of Medicaid coverage for the poor by 2020 and caps federal spending on the program — an overhaul that would cut spending by nearly $900 billion and nudge 14 million out of the program, according to CBO estimates.
“It’s a pretty remarkable document, particularly when you think about what was promised to the American people,” said Rep. John Yarmuth of Kentucky, the committee’s ranking Democrat.
Early on, Mr. Trump said his health plan would cover everyone and slash costs across the board, while leaving Medicaid untouched — promises that would be broken in the plan as written.
Mr. Yarmuth said he wasn’t even sure why he had to knock the plan in the wake of the CBO’s eye-popping analysis.
“I don’t know what else needs to be said when 24 million people will lose their health coverage if we pass this bill,” he said.
Yet the Republican Study Committee, an influential bloc of roughly 170 conservatives, said they are optimistic they can pull the plan further to the right. They want to reel in Medicaid even sooner, while requiring poor, able-bodied adults in the program to work, volunteer or attend school to obtain benefits.
The Freedom Caucus, meanwhile, is looking for a rewrite, saying its refundable tax credits are unacceptable and that estimated premium decreases fall short of what a free-market plan should achieve.
Republican leaders have begged for time by noting the reconciliation process constrains what they can do legislatively on the first try. Step two would involve regulatory changes and step three would involve more legislation that would have to face an expected Democrat-led filibuster in the Senate.
Some Senate Republicans said the House should slow down and develop a plan with broad party appeal, since Democrats will never help Republicans with reforms that are supposed to come in the third phase.
Democrats intent on preserving Obamacare by ramping up taxpayer-funded subsidies or introducing a government-run, “public option” to compete with private plans dialed up the pressure on Republicans Thursday.
Sen. Chris Murphy, Connecticut Democrat, rolled out a PowerPoint “rebuttal” of Mr. Ryan’s plan, while House Democrats held an informal hearing to highlight the effects of the GOP plan.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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