WASHINGTON ― House Speaker Paul Ryan (R-Wis.) acknowledged Wednesday there will have to be changes to the House Republicans’ health care bill, just as conservatives acknowledged that, short of a massive overhaul to the measure, they probably won’t support the legislation.
Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, emerged from the HFC meeting late Wednesday to suggest that Republicans may have to start over.
“We’re confident tonight that there are not the votes to modify this current bill to make it acceptable to conservatives and moderates alike,” Meadows said.
Pressed later on that point ― whether there were no changes leaders could make to win over conservatives ― Meadows walked his comment back and said that, if leaders were willing to negotiate “in good faith,” then maybe the Freedom Caucus could deal. But he stressed that the far-right’s biggest concern was the high cost of premiums and that the current bill “does not lower premiums in any meaningful way.”
For leaders like Ryan who seem to believe they can win over conservatives by giving in on minor changes like work requirements for Medicaid, the new focus of premiums can’t be welcome comments.
For the first time in the health care debate, Ryan acknowledged Wednesday what the White House has signaled for some time: that there will have to be changes. Ryan said now that Republicans have a Congressional Budget Office assessment on the legislation, they could “incorporate feedback” from members. Or, as Ryan put it earlier in the day, “We have consensus, and we’re fine-tuning that consensus.”
If you weren’t sure of the degree to which Ryan is now uncertain about the future of the bill, he refused to confirm that the measure would get a floor vote next week, deferring scheduling questions to House Majority Leader Kevin McCarthy (R-Calif.) and noting that the House had a snow day Tuesday.
That shift in tone and willingness to adopt changes were welcome signs for conservatives. “Ten days ago it was a binary choice,” former Freedom Caucus Chairman Jim Jordan (R-Ohio) said. “And now it’s a, ‘It won’t pass without change.’” (Jordan agreed he was taking some “literary license” with Ryan’s words.)
Consensus-tuning aside, conservatives recognize that it’s unlikely leadership will tear out the advance refundable tax credit portion of the bill, which far-right members hate but is the underpinning of the GOP’s replacement plan. The Freedom Caucus now seems focused on portions of the bill that would weaken coverage in favor of lowering premiums.
Conservatives have set their targets on the continuous coverage provisions that prevent insurers from discriminating against people with pre-existing conditions, as well as language that lays out essential benefits in coverage.
The current bill would allow anyone with a pre-existing condition to get insurance, but someone who chose not to be insured and then got sick would be subject to a 30 percent surcharge. In the conservative plan written by Rep. Mark Sanford (R-S.C.) and Sen. Rand Paul (R-Ky.), individuals have a two-year window to purchase insurance and then must maintain coverage. Switching to that system would lower premiums, but it also would leave many people who elect not to buy insurance devastated if they were to get sick.
“My understanding of where we’re at is we’re going to insist on a full repeal coupled with a repeal of the regulations.”
Meadows told reporters Wednesday that the Freedom Caucus would be producing an amendment later this week ― probably Friday ― that would address premiums. Although he wouldn’t go into specifics, sources indicated that the continuous-coverage element and eliminating plan requirements for essential health benefits, which mandate that insurers cover things like mental health and maternity care, would probably be the main focus of the amendment.
Meadows acknowledged that the Medicaid changes conservatives want could be a hang-up for moderates. Conservatives had wanted to accelerate the phaseout of the Medicaid expansion from 2020 to 2018, but members understand that change is probably a non-starter in the Senate and could imperil votes in the House.
Instead, Meadows said, the Freedom Caucus was now focused on an amendment that, he thought, could be supported by conservatives and moderates alike, “and truly, fundamentally, change the direction of this bill, where it actually lowers premiums.”
There are some immediate problems with such an amendment. For one, Republicans could run into problems in the Senate and a legislative rule that prevents reconciliation language from making policy changes. Another issue is that HFC members continue to insist that they want a full repeal of the Affordable Care Act.
“My understanding of where we’re at is we’re going to insist on a full repeal coupled with a repeal of the regulations,” Rep. Mo Brooks (R-Ala.) told The Huffington Post on Wednesday night.
Part of the reason Republicans preserve some portions of Obamacare is that repealing all of it would violate the so-called Byrd rule, which would require 60 votes in the Senate. Asked whether he thought it was likely that leadership would agree to those changes, Brooks was undeterred.
“It doesn’t make any difference whether they agree with it or not; that’s our position,” he said.
“They can work with the big government folks, or they can work with the little government folks. It’s their choice,” Brooks said.
Leadership doesn’t seem to be working all that much with conservatives. Meadows reported Wednesday night that, save an informal conversation he had with Majority Whip Steve Scalise (R-La.), he hasn’t communicated with leadership for two weeks. Meanwhile, he’s been in contact with the White House almost every day.
But Meadows believes Paul Ryan and other GOP leaders recognize they have to come to the table if they want to pass the health care bill.
“We are confident that, based on the whip count that we did today, that there are more than enough votes to assure that amendments need to be made,” Meadows said.
Meadows dodged questions about a specific vote count, but he said currently there were “definitely” more than 21 hard Republican votes against the bill, which would be enough to sink the legislation. “Much more than 21 hard noes,” Meadows said.
Asked if he meant overall or just in the Freedom Caucus, he said overall. And then he added that there were more than 21 in the Freedom Caucus too.
Jonathan Cohn contributed to this report.