In it, but not of it. TPM DC

House Minority Leader Nancy Pelosi (D-CA) on Friday morning called out Republicans for moving forward on a House bill to repeal and replace the Affordable Care Act without first seeing an analysis from the Congressional Budget Office.

“They are afraid of that," Pelosi said during a breakfast in Washington, DC, for reporters hosted by the Christian Science Monitor, referring to a CBO score that would project how much the bill would cost and how many people would lose their health insurance.

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The Republican bill to repeal the Affordable Care Act is moving full steam ahead—approved by two committees this week on party line votes—despite the fact that Congress' research arm has not yet issued its report on how much the bill would cost the government and how many people could lose their health insurance if it passes.

A report from the non-partisan Congressional Budget Office (CBO) is expected next week, and experts at the Brookings Institute—who have performed their own analysis of the bill—predicted it will bear bad news for Republicans.

"CBO’s analysis will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window," wrote Brookings analysts Loren Adler and Matthew Fiedler. "Estimates could be higher, but it’s is unlikely they will be significantly lower."

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The Republican House leaders pushing the passage of the GOP's Obamacare repeal and replacement legislation shot down Friday the idea that they'd be open to negotiating how the bill handles Medicaid expansion. Conservatives are lobbying to speed up the process by which Republicans aim to phase out the program, by requesting that its enrollment be frozen in 2018 instead of 2020, as it is under the current plan.

"I think right now, that would be very difficult to do," House Majority Leader Kevin McCarthy (R-CA) said at press conference, when asked it leadership was open to the idea.

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Republicans in Congress are in a bind. House conservatives are complaining that the Donald Trump-endorsed bill to repeal the Affordable Care Act retains or replicates too many of its rules and provisions. But if these members prevail in stripping out those provisions, the bill has no chance of passing the more moderate Senate—where any non-budgetary modifications to the health care law must clear a 60-vote threshold and where Republicans currently hold only 52 seats.

To solve this conundrum, Freedom Caucus member and current holdout on the bill Rep. David Brat (R-VA) told reporters Thursday that the Senate should blow up its 60-vote rule and push the bill through with 51 votes—overruling the Senate parliamentarian. Brat described it as "going nuclear," a term which in recent political history has meant blowing up the Senate filibuster. This is a different scenario, but the upshot would be similar: avoiding a Senate filibuster.

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Republicans pushing for passage of GOP leadership's Obamacare replacement bill were able to head off a major intra-party fight over how the legislation handled Medicaid expansion -- at least for now, as supporters of phasing out expansion even sooner than the current bill withdrew an amendment to that effect Thursday.

Under the leadership's bill, the American Health Care Act, Medicaid expansion would be allowed to continue until the end of 2019, at which point enrollment would be frozen, with the expectation that the program would wither away on its own. Conservatives are pushing for that deadline to come sooner, and Wednesday, during the mark up of the AHCA in the Energy and Commerce Committee, Rep. Joe Barton (R-TX) introduced an amendment that would have frozen the program at the end of 2017. By Thursday morning, as criticisms of the idea from expansion state Republicans began to rack up, the amendment had been withdrawn and the bill passed by the committee with its expansion provisions as is.

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Conservatives who have been dissatisfied with the Obamacare repeal and replacement bill put forward by House leadership this week are mobilizing around making a major change to how the legislation handles the Affordable Care Act's Medicaid expansion.

The topic came up in a Wednesday meeting between the leaders conservative organization and President Trump, and by Thursday morning, an influential group of conservative House members endorsed speeding up the process by which the GOP bill would wind down the expansion.

The changes would please hardline conservatives in the House Freedom Caucus, who have introduced their own bill to strip away the Medicaid expansion over two years, but it would alienate moderate Republicans whose states have expanded Medicaid under the Affordable Care Act to cover millions of low-income residents.

With the fate of the GOP bill to repeal the Affordable Care Act in jeopardy, Trump huddled Wednesday night with outside conservative groups—including the Koch brothers' Americans for Prosperity, the Heritage Foundation and the Tea Party Patriots—to debate the most sensitive and divisive questions surrounding the health care overhaul.

In that meeting, the president heard the concerns from the conservative members that Medicaid expansion was being allowed to continue under the leading House GOP health care overhaul bill, and he was reportedly open to negotiating around their demands.

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At the core of the Republican sales pitch for their Obamacare replacement is the the promise of lower premiums. The problem is they don’t have much in their bill to point to that will, without a doubt, fulfill that promise.

It's not the cure to the Obamacare ailment that conservatives were looking for.

“It doesn’t change an awful lot,” said Joe Antos, a health care policy expert at the right-leaning American Enterprise Institute.

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A major trade organization for the insurance industry raised a number of a concerns with Republicans' health care legislation in a letter to GOP leaders surfaced by Bloomberg Wednesday.

The letter, from Marilyn Tavenner, the CEO of America's Health Insurance Plans, called for more generous tax credits for consumers to use on the individual market and was skeptical with the bill's proposal to transform Medicaid into a block grant program with a per capita cap.

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