Members of the House’s conservative Republican Study Committee emerged from a meeting with President Donald Trump on Friday more eager to support the embattled health care repeal bill that GOP leadership is aiming to bring to a House floor vote next week.
“One hundred percent of the noes were now yeses,” Trump boasted.
Several lawmakers who were in the White House meeting confirmed to TPM that two promised changes to the bill were enough to flip them from no or undecided to yes: a provision to allow states to impose work requirements on able-bodied Medicaid recipients, and another giving states the option of getting their Medicaid funding in a block grant instead of the per capita capped funding system the current version of the legislation proposes.
RSC Chair Rep. Mark Walker (R-NC) told reporters these changes will be introduced as an amendment to the American Health Care Act in the Rules Committee markup next week.
“We had eight members of our steering committee who were undecided or no. Based on these two requests, all moved to ‘yes’ today,” he said.
According to lawmakers who attended the White House meeting, previous top concerns with the bill, including moving up the Medicaid freeze to 2018 and reworking the tax credits to better support the elderly and the poor, were not discussed.
Still, several RSC members gushed about the transformative power of Friday’s discussion, saying Trump listened to each member’s concerns and pressed each one individually to back the legislation.
“I went in leaning no and I came out in favor,” Rep. Andy Barr (R-KY) told reporters. “With the assurances we got today, I feel a lot better about the direction we’re going in.”
“Many of us were undecided or had reservations, but based on the changes that the president supports, we are much more comfortable with the legislation,” Rep. Jim Banks (R-ID) told TPM. “The block grants for the states was a significant item for me.”
Even Rep. Gary Palmer (R-AL), who voted against the bill in the Budget Committee just one day ago, told TPM the proposed Medicaid changes are so sweeping that he is a proud convert.
“This will be the most significant entitlement reform we’ve ever seen,” he said.
Asked if these changes alone were enough to flip his vote, Palmer appeared astounded.
“Enough? This will be historic,” he said of the Medicaid block grants and work requirements. “I don’t think there’s a member in this Congress who has been around long enough, except maybe for [Rep.] John Conyers [D-MI], who have ever had the chance to vote on something like this. It’s really going to help states get control of their budgets.”
Palmer explained that he voted no in committee to ramp up the pressure to force these changes to be made.
“We tried to intellectually engage but sometimes you have to take other actions to get attention, and it worked,” he said. “Of course, it caused some consternation. But the work the RSC did in sticking to our guns shows this place can work sometimes.”
A study released in 2016 by the Center for Budget and Policy Priorities found that most Medicaid recipients who are physically able to work already do so, and imposing a work requirement for enrollees would do nothing to increase the work force in the long term. “Its main effect likely would be the loss of health coverage for substantial numbers of people who are unable to work or face major barriers to finding and retaining employment,” the study found.
The Kaiser Family Foundation estimates that only 27 percent of Medicaid recipients are adults without disabilities, and 60 percent of that group are already working. Many of those not employed care for a family member full-time, have a criminal record, live in an area without job opportunities, or face other “major impediments” to employment.
Still, Palmer insisted the requirement would ensure that funding for Medicaid, to which the federal government will contribute a share that will shrink over time under the GOP proposal, goes to those who need it most.
“As someone who grew up dirt poor—I mean, my brother and I shared a bedroom and we had cardboard between the two sides—I know how important this is,” he told TPM.
But even as the leaders of the 170-or-so member Republican Study Committee come around on backing the health care repeal legislation, the message from the more hardline Freedom Caucus Friday was, not so fast.
Rep. Mark Meadows (R-NC) updates reporters on health care negotiations.
House Freedom Caucus Chair Mark Meadows (R-NC) told reporters that the proposed changes, the text of which has not been made public, “doesn’t change my whip count, which indicates that there are 40 noes.”
If Democrats remain united in opposition to the bill—which is highly likely—Republicans can only afford to lose House 20 votes from their side of the aisle, giving the Freedom Caucus significant leverage in the days to come if Meadows’ whip claims are true.
Meadows and other Freedom Caucus members said the changes proposed Friday are not only insufficient, but flawed.
“Is the definition of oxymoron ‘mandatory optional work requirements’? A mandatory work requirement should be just that,” Meadows said.
He was similarly critical of the optional block grant provision, saying: “They’re all going to pick per capita. I don’t know of one state that will pick a block grant. It’s good that they can if they want to, but I’d be surprised if more than a handful did.”
Fellow Freedom Caucus member Rep. Morgan Griffith (R-VA) told TPM he agrees. “If they can continue with the current system or do a block grant, that makes me a little uncomfortable. It does,” he said. “It’s always hard to get people to change. If you say, ‘We think this is better in the long run, but you have to adjust everything you’ve been doing now.’ Most states are going to say, ‘Yeah, let’s not do that.'”
Griffith also questioned whether the changes proposed Friday can make it through the Senate’s Byrd Rule, which requires that any legislation that hopes to squeak by with only 51 votes via the so-called reconciliation process decreases the federal deficit.
“I prefer optional [Medicaid work requirements], because we should be giving maximum flexibility to the states, but we may be in better shape with the Byrd Rule if it’s mandatory,” he said. “If it’s optional, they’ll assume that no one will do it, therefore it won’t save any money, therefore it has no impact on the budget. That’s the problem.”
As the Trump administration and GOP leaders continue to pressure Congress to pass the bill currently on the table, and a host of outside groups ramp up their lobbying efforts both for and against it, Griffith said it would not be “the end of the world” if the bill went down in flames.
“You never want to lose when you’re in the majority, but sometimes you’re going to lose,” he said. “Welcome to legislation. Is it great? No. Is it the end of the world? No. If this one fails, we’ll do something different. It’s not a crisis, it’s a bump in the road.”