Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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President Donald Trump in his address Tuesday to a joint session of Congress gave GOP congressional leadership a vague but important assist in getting their caucus on board with their Obamacare repeal plan.

Without going into much detail, Trump name-checked the major elements of a replacement package that has been floated by Republican leaders and was leaked in a draft legislation last week. Perhaps, most importantly, he called for tax credits for individuals to buy insurance -- which GOP hardliners have been vocally resisting -- as well as less controversial elements of the package, like expanded health savings accounts and allowing insurers to sell across state lines.

"We should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts –- but it must be the plan they want, not the plan forced on them by the Government," Trump said, according to his prepared remarks.

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The congressional Republican hardliners who have revolted against proposals floated in a leaked draft of a GOP Obamacare replacement plan now have the support of two outside conservative groups, Club for Growth and FreedomWorks

In a statement Tuesday titled "Club for Growth Supports Conservative Opposition to GOP Effort to Retain and Repair Obamacare," the group's president David McIntosh said that it "stands" with the members who have signaled objections to the recently surfaced text, which would include several Obamacare replacement provisions within the repeal bill Republicans are hoping to pass this spring. Likewise, the Tea Party group FreedomWorks said in a statement from CEO Adam Brandon that Republicans should follow the model of a 2015 bill that dismantled major parts of the law but was vetoed by President Obama.

"After nearly seven years, it's time for Republicans to follow through on their promises and repeal ObamaCare by using the 2015 reconciliation bill as the baseline,” Brandon said. “It would be a stunning level of political hypocrisy if Republicans failed to follow through. Thankfully, principled conservatives are fighting for full repeal, not a watered down bill or ObamaCare-lite.”

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Alice Ollstein contributed reporting.

The movement to repeal the Affordable Care Act appears to be approaching a do-or-die moment for Republicans, as the clock ticks on dismantling Obamacare in time to also tackle tax reform before Congress's summer recess. Many of the differences that dogged Republicans about repealing and replacing the law remain. But GOP lawmakers, particularly in the House, seem intent on moving forward, if a leaked a draft of legislation is of any judge.

Congressional leaders are signaling a “now or never” strategy that will dare the Republicans to stand in their way, regardless of their disagreements over the details of repealing the Affordable Care Act, according to a Wall Street Journal report.

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The chairman of a group of House conservatives known for causing GOP leadership problems is already resisting Obamacare replacement proposals surfaced in leaked Republican draft legislation.

Rep. Mark Meadows (R-NC), who heads the House Freedom Caucus, told CNN Monday he would vote against a bill that looked like the leaked draft, and that other conservatives had similar concerns about the proposals' tax credits for individual insurance as well as its tax on the most generous employer-based plans.

"What is conservative about a new entitlement program and a new tax increase? And should that be the first thing that the President signs of significance that we sent to the new President?" Meadows said "A new Republican president signs a new entitlement and a new tax increase as his first major piece of legislation? I don't know how you support that -- do you?"

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President Donald Trump told a bipartisan group of governors at a White House reception Monday morning that GOP tax reform would have to wait for lawmakers to move on repealing Obamacare, cautioning that, "Nobody knew that health care could be so complicated."

"I have to tell you, it's an unbelievably complex subject," Trump said.

For health policy experts and Democrats who spent the last eight years overhauling the nation's health care system in the face of GOP intransigence, Trump's admission that health care is hard dripped with irony. Republicans, in the mean time, voted repeatedly to repeal the Affordable Care Act, but made little progress on settling on what their replacement would look like, a conundrum that is haunting them now.

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Republicans are considering phasing out Obamacare's Medicaid expansion in their Affordable Care Act repeal. As part of the phase out, they would allow the Medicaid expansion states to "freeze" the acceptance of new enrollees, while non-expansion states would be given additional funding from a separate mechanism to "level the playing field" among the states.

The idea comes as a major fight is brewing internally among Republicans over whether to dismantle the Medicaid expansion when they attempt to repeal the Affordable Care Act this year. However, many of the details are yet to be worked out, and it's unclear how it would fit within GOP lawmakers' plans to block grant the Medicaid program, which is a major priority in their health care overhaul.

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To pay for their Obamacare replacement provisions, House Republicans are considering imposing a major change to the tax treatment of employer-based insurance plans as part of their legislation to repeal the Affordable Care Act.

House members coming out of a GOP-caucus meeting Thursday on their health care overhaul plans said that capping the tax exclusion for employer plans -- i.e. imposing a monetary limit at which point health benefits are taxed like other forms of income -- was discussed as a potential revenue booster. The proposal is somewhat like the ACA's Cadillac tax, which was hated by Democrats and Republicans alike, and is often included in GOP replacement plans, including the "Better Way" outline offered by Speaker Paul Ryan last summer. Capping the exclusion could solve the problem for Republicans of how to pay for their replacement, as many of them have said that the ACA's current taxes need to be repealed right away. But since it will affect the types of plans used by a vast plurality of Americans, it won't come without a political fight.

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How to deal with Medicaid expansion has become the latest sticking point in Republicans’ effort to dismantle the Affordable Care Act. While most lawmakers acknowledge it’s a major source of tension, there appears to have not been any decisions made yet as to whether states should be able to keep their expanded eligibility -- and whether the federal government should continue to subsidize a vast majority of it.

“That’s the $94 question, and I think there will be an incredible tug of war,” said Rep. Mark Sanford (R-NC), a House conservative who unveiled his own Obamacare replacement plan Wednesday.

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A group of conservative House Republicans on Tuesday made explicit their preference for using 2015 Obamacare repeal legislation as the model for dismantling the Affordable Care Act this spring. That may be more of a negotiating position than a hardline stance, however.

The lawmakers weren’t ready to say if they would definitively vote against any repeal legislation that didn’t go as far as the 2015 bill. Nor did they rule out supporting replacement measures being added to that repeal legislation, though they had concerns that adding provisions to the 2015 bill was bogging down the repeal effort.

“The 2015 bill that we all voted for in both the House and the Senate is the floor,” Rep. Scott Perry (R-PA) told reporters at the monthly Conversations with Conservatives. “If there's something else in there, we’ll take a look at that. But we don't want to be heading in the wrong direction.”

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A trio of conservative House members said Tuesday that they were open to further congressional investigations into accusations that retired Lt. Gen. Michael Flynn, who resigned as national security adviser Monday night, had inappropriate contacts with Russia during the presidential transition.

The Republicans, speaking with reporters on Capitol Hill at their monthly "conversations with conservatives," said that the intelligence committees should first work with the intelligence community to get a better understanding of what communications did occur between Flynn and Russian officials, but that they supported a broader investigation if the intel communities found it warranted.

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