In it, but not of it. TPM DC
On Tuesday, the roughly 40-member strong House Freedom Caucus came out against the legislation, vowing to withhold their votes until they can force leaders to strip away the provisions they say are too close to the Affordable Care Act they have vowed for seven years to kill. They have also introduced their own alternative: a copycat of the 2015 repeal bill that passed Congress and was vetoed by President Obama.
"Look, did we promise the American people we were going to repeal Obamacare but keep some of the Obamacare taxes?" Freedom Caucus member Rep. Jim Jordan (R-OH) asked reporters Tuesday. "Did we promise the American people we were going to repeal Obama care but keep and expand Medicaid? And did we promise the American people we were going to repeal Obamacare but create a new entitlement with the fancy name of refundable tax credits? I don't think we did."
Rep. Jim Jordan (R-OH) backed by other members of the House Freedom Caucus on Capitol Hill, March 7, 2017.
An even larger conservative faction—the 170-member Republican Study Committee—is also slamming the proposal comparing the tax credits to "a Republican welfare entitlement" in a memo obtained by Bloomberg.
If either they or the Freedom Caucus vote as a bloc, and if Democrats remain united in opposition to the bill, they will have the numbers to stop its passage in the House. But in the unlikely event they win sufficient concessions and revisions on major provisions like the Medicaid expansion and refundable tax credits, they will almost certainly lose votes in the Senate, where Republicans have an even narrower majority and where many Republicans support protecting states that have expanded Medicaid and offering tax credits to people who make below $75,000 a year.
"There has to be some vehicle for making health care affordable," Sen. Thom Tillis (R-NC) told TPM. "And hopefully we bend the curve over time so that will diminish over time. But right now we have these spiraling costs and we have to deal with the transition."
Two senators, Sen. Mike Lee (R-UT) and Sen. Rand Paul (R-KY), have already come out against the bill, calling it a "step in the wrong direction" and a "missed opportunity." They are particularly opposed to how the GOP leaders' bill treats the Medicaid expansion under Obamacare: allowing states to expand the program for low-income residents until 2020, at which point the program is frozen and transformed into block grants in the form of per capita allotments for all of Medicaid. Under the alternative conservative plan, the Medicaid expansion would be completely rolled back over two years, jeopardizing coverage for 11 million people who have joined the expansion since 2014.
But a concession on Medicaid to please House and Senate hardliners could cost them the votes of at least four Senate Republicans who wrote to party leaders this week saying they will oppose any plan that "does not adequately protect individuals and families in Medicaid expansion programs or provide necessary flexibility for states."
"We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals," said Senators Rob Portman (R-OH), Shelley Moore Capito (R-WV), Cory Gardner (R-CO) and Lisa Murkowski (R-AK).
Gardner refused to answer Tuesday whether he would support the current Medicaid provision in the bill, telling reporters only that he and others are "working through the language."
At least two more GOP lawmakers—Lisa Murkowski (R-AK) and Susan Collins (R-ME) oppose the bill's provisions to defund Planned Parenthood.
Asked if the bill could go down in the Senate, Sen. Marco Rubio (R-FL) quipped to reporters, "Anything's possible."
The intra-GOP divisions may be exacerbated going forward by powerful conservative think tanks and outside action groups who plan to turn up the pressure on lawmakers to oppose the bill. The conservative groups FreedomWorks, Heritage Action, and Americans for Prosperity blasted GOP leaders' plan on Tuesday, and vowed to spend money on ads targeting lawmakers who support it.
But some, including Tillis, say they will not let this pressure change their vote.
"I'm not prepared to let any outside groups influence what we do inside this building," he said. "I don't have a problem with those outside who don't have the responsibility or actual experience passing laws striving for some perfect position. But on a good day we get good out of here. We never get perfect."
While warning of the dangers of the GOP's health care bill, which could push millions of people off their insurance plans, Democrats appeared well aware of and pleased by the infighting in the Republican caucus over how to proceed.
In a speech on the Senate floor Tuesday evening, Sen. Brian Schatz (D-HI) summed up the GOP's predicament: "In trying to make everyone in their caucus happy, they've made no one in their caucus happy."