House Republican leaders are making a last-ditch attempt to win enough support to pass their Obamacare repeal, revealing an expansive series of changes to the bill on Monday night designed to woo wary GOP lawmakers.
Requested by President Donald Trump, the amendment includes perks for restive conservatives who wanted optional work requirements and block granting in Medicaid, as well as a potential olive branch to wary centrists who demanded more help for older Americans to buy insurance, POLITICO has learned.
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But it is still unclear whether the changes are enough to win over the 216 Republicans needed to pass the measure in a high-profile vote planned for Thursday. GOP leadership insiders and White House officials firmly believe the changes will corral the necessary votes. But several rock-ribbed conservatives emerged from a closed-door session Monday night vowing to vote against the bill, and bragging that they have the votes to block it.
"House leadership does not have the votes to pass this very liberal bill unless they have a bunch of Democrats on board!" declared Rep. Mo Brooks (R-Ala.) while exiting the meeting. He called it a "the largest Republican welfare bill in the history of the Republican Party."
The changes to the bill come just a few hours before Trump will address the full House GOP conference. He's expected to urge them to vote for the bill. House Speaker Paul Ryan and his top lieutenants have been meeting with holdout moderates to find out what's needed to secure their support, while White House budget director Mick Mulvaney, a former Freedom Caucus member, has been working the far-right.
The mangers amendment is expected to entice some to vote "yes" on the bill, on both sides. For moderate and centrist Republicans, it would set aside funding — about $85 billion, according to Republican sources — for tax credits to help Americans between 50 and 64, who would see their premiums skyrocket under the current repeal plan. The amendment would not set up the tax credits but would instruct the Senate to do so, forcing House Republicans to take a vote on something the upper chamber would do later. It would be paid for by allowing consumers to write off less medical debt.
The boost for Baby Boomers was designed to counter the huge financial hit that Americans in that age group would take under the bill. The Congressional Budget Office said last week a 64-year-old making $26,500 would have paid about $1,700 for an insurance policy under Obamacare. But under the repeal plan, that would jump to about $14,600, CBO said.
That number scared a bunch of centrists on Capitol Hill. The powerful interest group AARP mobilized its members to oppose the bill in part because of the potentially huge cut to Baby Boomers.
Trump wanted the beefed up tax credit in part because voters that age are a core element of his constituency and helped propel him to the White House:
The bill also includes provisions nodding at anti-abortion GOP leaders. Among other changes to the repeal bill, the amendment would delete a provision that would have allowed consumers to move leftover tax credit money into a Health Savings Account. Anti-abortion groups had raised concerns that the provision might be eliminated under the Senate's strict budget rules and inadvertently allow for taxpayer funding of abortion.
After learning of the change, at least one member of the pro-life caucus— Rep. Vicky Hartzler — told POLITICO she changed her vote to "yes."
It also includes some red-meat for the right. Two of the changes, first reported on Friday, were essential to winning over the support of the Republican Study Committee. Trump met with leaders of the conservative group last week and agreed to allow work requirements in Medicaid as well as give states the option of converting their Medicaid programs into block grants. Both concessions were heralded by conservatives as necessary modifications to the health entitlement and long-term wins. Some states sought work requirement approval under the Obama administration, but were rebuffed by federal officials.
The amendment also speeds up the repeal of about a dozen Obamacare taxes a year earlier than originally planned, a win for conservatives who want to eliminate the Affordable Care Act as quickly as possible. It would also delay the implementation of the Cadillac tax again, this time from 2025 to 2026.
House GOP leaders also threw the New York delegation a bone to secure a whole host of "yes" votes. The amendment included a targeted change to Medicaid funding that's specifically designed to garner support from New York's delegation. It would attempt to transfer more Medicaid spending from counties to the state, by blocking New York from obtaining federal reimbursements for payments made by counties.
Rep. Chris Collins and other New York Republicans have been pushing leaders to add the amendment. Rep. Claudia Tenney told local reporters that the inclusion of the amendment would be essential to win her support for the whole repeal bill.
The amendment would also change federal Medicaid reimbursement rates for the elderly and disabled, a win for governors who were concerned about cuts.
In spite of all the changes, conservatives in the House Freedom Caucus are still defiant about the bill. Freedom Caucus Chairman Mark Meadows told reporters Monday evening that the negotiations on the bill appear to be over. But he doesn't think it's necessarily the end.
"I'm confident that we have enough concerns that a vote of 216 votes in the House would not happen today," he said.
John Bresnahan, Rachana Pradhan and Paul Demko contributed to this report.