A House GOP bill to repeal and replace Obamacare sped toward a risky, take-it-or-leave-it floor vote late Friday, after President Trump threatened to move on unless the party backed his plan.
The White House and GOP leaders made a final push to get party holdouts to “yes” on the bill, which hurdled an early procedural vote to kick off debate and finalize last-minute changes to insurance regulations and the Medicaid program for the poor.
Yet clouds gathered around the bigger, make-or-break vote later on. House Appropriations Committee Chairman Rodney Frelinghuysen of New Jersey announced his opposition to the bill, while six conservatives balked during the procedural roll call.
The spectrum of opposition underscored the urgent task before House Speaker Paul D. Ryan and his whip team, as they reach for victory in Mr. Trump’s first major legislative test.
Mr. Trump said Republicans who rebuff him will have to live with Obamacare and explain their votes back home, because there is no Plan B.
“It’s back to square zero,” said Rep. Mark Walker, North Carolina Republican and chairman of the Republican Study Committee.
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Republicans can’t afford to lose more than 22 votes, because no Democrats are expected to vote for the plan, which repeals most of Obamacare’s taxes and its mandate requiring Americans to hold insurance, replaces its generous subsidies with refundable, age-based tax credits and reins in and caps spending on the Medicaid program for the poor.
It also strips Planned Parenthood of federal funding as punishment for its abortion practice.
Mr. Trump said that alone should be enough to sway the “very pro-life” House Freedom Caucus, a group of 30-plus conservatives who’d threatened to withhold their votes and tank the bill, saying it doesn’t repeal enough of Obamacare.
The president’s gambit could devastate his own agenda if it fails. For instance, Republican leaders are counting on health reform to set the table for tax cuts later in the year.
Rep. Mark Amodei, Nevada Republican who said he will reject the bill because it harms his state, said GOP leaders could have built consensus through a methodical committee process.
“Get the governors here and put ’em on the record,” he said. “Get the health insurers companies and put ’em on the record. Get pharma here and put ’em on the record.”
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The Congressional Budget Office estimated the plan would save $150 billion but result in 24 million fewer people holding insurance a decade from now, an eye-popping figure that belied Mr. Trump’s push to get “insurance for everybody” in the plan.
Democrats intent on preserving Obamacare called Republicans reckless, saying their plan would harm the sick and needy and is opposed by hospital groups, the AARP and free-market conservatives alike.
They also said Republicans will pay a price at the ballot box when their supporters see deep cuts to Medicaid and regulations that let insurers charge older Americans up to five times what they force younger customers to pay.
“What does the GOP stand for? ’Get Old People.’ That’s what this bill does,” Rep. Rosa DeLauro, Connecticut Democrat, said.
A successful House vote would hardly be the final word on the effort. Senate Republicans who hold a slim, 52-seat majority have expressed deep concerns about the legislation.
Also, a series of changes designed to win House support only made it harder to meet arcane budget rules and avoid a Democratic filibuster in the upper chamber, meaning Republicans must thread fiscal and political needles at the same time.
The last-minute changes included zeroing out Obamacare’s federal mandate on essential health benefits, which required all plans to cover maternity care, prescription drugs, mental health and other services. Conservatives said those mandates made customers pay for care they may never need.
Republicans said the pushback was overblown, since the legislation leaves coverage requirements up to states.
“Governors have been asking for this,” Rules Committee Pete Sessions, Texas Republican, said.
GOP leaders also said they will keep one of Obamacare’s taxes on high-income workers for six more years, freeing up $15 billion to add to a fund designed to help states cover customers with specific needs and health conditions.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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