Alice Ollstein contributed reporting.
After being steamrolled in the negotiations surrounding Obamacare repeal, House Republican moderates appear poised to be run over once more—and perhaps, a final time—as momentum grows behind a revived version of the repeal bill.
Their rival faction, the House Freedom Caucus, has backed the newest form of the legislation having received another round of concessions. That means the pressure is on the conference’s centrist wing to fall in line, despite having gained little throughout the negotiation process.
Moderates who have been steadfastly opposed to the direction things were headed with the bill, the American Health Care Act, remained skeptical of the true purpose of the latest round of deal-making. The GOP centrists who were previously supportive or undecided are clamoring for more time to understand the new changes to the bill and what they mean for the legislation or even for their political careers.
“I’ve often felt that a lot of this has been simply an exercise in blame-shifting, because we know that this bill, in its current form, with or without the amendment, will be gutted in the Senate,” Tuesday Group co-chair Charlie Dent (R-PA), a consistent “no” vote on AHCA, told reporters Wednesday. “So this is simply a matter of blame shifting and face saving.”
Rep. Mario Diaz-Balart (R-FL) (pictured above), a yes vote on the original legislation, said Wednesday he was withholding “judgment” on the new changes until he studied them further.
“I’ve got to look at the impacts and see what it does,” he said.
The original bill would have cost 24 million people their health care coverage over the next 10 years, according to estimates by the CBO. It would begin scaling back Medicaid expansion in less than two years (a loss for the moderates who hail from expansion states) while making major cuts to the broader Medicaid program over time. It shifted the ACA’s tax credits in a way that benefited young people while short-changing older consumers, another element moderates were uncomfortable with. These cuts pave the way for the elimination of many of Obamacare’s taxes, mainly for the industry and high-income earners.
All those provisions remain in the new version of the bill, but instead an old provision that would have gutted the ACA’s essential health benefits is now optional for states to waive into.
The latest changes, hammered out by Freedom Caucus Chair Mark Meadows (R-NC), and one of the moderates’ own, Tuesday Group co-chair Tom MacArthur (R-NJ), allows states to opt out of ACA insurer mandates in a way that would essentially gut its pre-existing conditions protections, the Holy Grail of the promises many Republicans made about their replacement.
“I spent the whole work period hearing from people pissed about pre-existing conditions,” one moderate lawmaker told CNN on Wednesday. “This isn’t helpful.”
Another moderate was overheard by the Hill telling a staffer: “If I vote for this healthcare bill it will be the end of my career.”
Moderates got almost nothing in return in this new “compromise,” and were already uncomfortable with the legislations massive cuts to Medicaid and how it structured tax credits for individual insurance. Many centrists who are still weighing whether to vote for the bill admit that it’s only been pulled to the right since the original legislation was pulled from the floor.
“There’s been some moving of the goal posts that have been concerning to a lot of us,” moderate Rep. Tom Reed (R-NY) told reporters Wednesday, adding that in general he is in favor of more control for the states. A previous yes vote, he described himself as a lean yes while he looked over the latest changes.
The pressure is amping on them to hold their nose, with White House officials telling the press they’d like to hold a vote as early as this weekend.
“I think anybody who is wavering feels some pressure because the vast majority of our conference wants to pass this bill,” MacArthur told reporters Wednesday, according to CNN.
It’s unclear how many moderate votes GOP leadership will need to flip to yes on the bill to make it passable.
“You might be able to get there without them,” said Rep. Tom Cole (R-OK), a leadership ally who is not a moderate and has been supportive of the bill. “But look, we want something that everybody feels comfortable voting for. Our leadership is certainly not trying to deal anyone out of the game.”
The Freedom Caucus was widely blamed for the failure of the original bill, but the morning that it was pulled, it was the last minute statements of oppositions from non-Freedom Caucus Members, such as House Appropriations Chair Rodney Frelinghuysen (R-NJ) and moderate Rep. Barbara Comstock (R-VA), that felt like the death knell. Since many moderates were still publicly unclear or undecided, it’s unknown exactly how many votes GOP leadership had been deprived from the moderate wing in order to mount them to 216 votes.
Office of Management and Budget Director Mick Mulvaney said earlier this month that the White House’s internal whip count showed that moderates made up about half of the 36 votes against the original AHCA.
When all is said and done, the White House can only afford to lose 22 votes total and still pass the bill. Ten or 11 moderates so far, according to various outlets’ whip counts, have already came out against the new version and dozens more remain unclear.
Amidst all this is frustration that MacArthur worked with the conservative hardliners in the first place. At Wednesday’s Tuesday Group meeting after the new changes were unveiled, some members vented their frustrations with MacArthur for putting them in this position, two aides told the Hill. Dent told reporters after the meeting that members of the Tuesday Group had previously communicated to all the co-chairs that they’d prefer the negotiations be left to those on the relevant committees.
“Many of the members of the Tuesday Group made it very clear to me that they didn’t want me or anyone else negotiating,” Dent said.