Republicans are racing to put the finishing touches on a health care plan that may need sweetening to avert an ugly clash with conservatives who have blasted the effort as secretive and substandard, as House leaders enter a three-week sink-or-swim stretch for unifying around a plan to repeal and replace Obamacare.
Vice President Mike Pence said the Trump administration and congressional Republican leaders were fine-tuning the plan over the weekend so they can begin to dismantle the Affordable Care Act in “just a matter of days.”
“Let me make you a promise: The Obamacare nightmare is about to end,” he said Friday in an appearance with Health and Human Services Secretary Tom Price and House Speaker Paul D. Ryan in Janesville, Wisconsin.
Republicans are trying to repeal and replace as much of the 2010 health care overhaul as they can under a fast-track budget process that allows them to avoid a Democratic filibuster in the Senate.
Yet party leaders are on a collision course with conservatives who say they haven’t liked what they have and need to digest the latest version before imminent markups in the House Energy and Commerce and tax-writing Ways and Means committees.
Vocal conservative groups and a trio of Republican senators — Rand Paul of Kentucky, Ted Cruz of Texas and Mike Lee of Utah — particularly don’t want to provide refundable, age-based tax credits to people who purchase insurance on their own, while paying for it by taxing a portion of particularly generous employer-sponsored plans.
Negotiators are reportedly mulling an income-based cap on the credits, so the overall plan would cost less and wouldn’t dole out assistance to wealthy people who don’t need it — changes that could make it more attractive to party holdouts.
Some Republican lawmakers touted the idea after emerging from a closed-door meeting on health care before leaving town for the weekend.
“I certainly would favor that,” said Rep. David P. Roe, Tennessee Republican, using his own pay to illustrate his point. “I don’t think I need a refundable tax credit.”
Some conservatives said they won’t be able to decide whether the changes are enough to earn their support until they get the latest text of the committees’ proposals. For now, they are pushing for a more straightforward repeal, with replacement efforts moving alongside it.
“We can’t repeal an entitlement and replace it with another one,” said Jason Pye, director of public policy and legislative affairs for FreedomWorks, a conservative pressure group. “The approach the discussion draft took was a new entitlement. If there are controls put in place, we’ll review the text and determine our path forward.”
Democrats intent on preserving the law have ribbed their Republican rivals, saying they still cannot produce the votes to repeal a law they have blasted for seven years despite snatching all the levers of political power in the November elections.
But proponents of the House Republican plan say the naysayers are underestimating the influence of Mr. Trump, who can rally votes with a tweet, and Mr. Ryan, who has eyed entitlement reforms for most of his career.
“They’ve had this ’Better Way’ plan out there since this summer,” said John Desser, a former Bush administration health official and vice president for government affairs at eHealth, a website that connects users with private insurance. “A consensus document doesn’t mean a unanimous document.”
“I am optimistic about its contents and its likelihood of passing the House, and I’m hopeful of it passing the Senate with the extraordinarily gravity-defying, art-of-the-deal capabilities of the new president,” he said. “Paul Ryan may have been born for times just like this, because he is supremely situated and prepared to shepherd this through the House. He’s been working on this for 20 years. This is not some side issue for him.”
Republican leaders have little margin for error, however, because the party holds a narrow 52-seat majority in the Senate. Some centrists Senate Republicans are worried about unwinding Obamacare’s expansion of Medicaid for the poor or defunding Planned Parenthood as part of the health care overhaul, and could join the trio of conservatives who say they are creating another entitlement.
“The House is going to send something over, and you either take it or leave it,” Mr. Paul told CNN about the Republican leadership’s approach. “But I can tell you right know conservatives are inclined to leave it.”
Relevant committees have said they aren’t trying to hide anything, but rather fine-tune their legislation before it is held out for debate and amendments.
A revised version of the Republican draft bill, dated Feb. 24 and reported by Politico, retains the tax credits but would tighten the verification process for employed people, who must prove they don’t have access to adequate insurance through their jobs.
The report also confirmed that drafters are discussing the income-based cap on tax-related assistance in the plan.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
Please read our comment policy before commenting.