It was always going to be difficult for Republicans to get a plan to repeal and replace the Affordable Care Act through the Senate, where losing as few as two senators would require Vice President Mike Pence to cast a tie-breaking vote, and losing three would doom the measure to failure. But now that the legislative language of the bill is public, it’s beginning to look as though even getting the bill through the House of Representatives will be a tough slog.
The text of the proposed American Health Care Act had been a closely-held secret until it was released, and now that the more conservative members of Congress are getting a good look at it, they aren’t happy.
The ACHA would replace the income-based subsidies available under the Affordable Care Act with age-based premium supports in the form of refundable tax credits, something many lawmakers in the ultra-conservative House Liberty Caucus object to.
Liberty Caucus chair Justin Amash (R-MI) tweeted out a succinct condemnation of the bill Monday night, calling it “Obamacare 2.0.”
Texas Rep. Louie Gohmert complained, “It creates a new entitlement program and I've already heard from some constituents upset about [it]. We're calling it tax credits, where we actually send people checks. I guess it's another way to do the subsidy.”
Members of the influential House Freedom Caucus also came out against the bill.
Virginia Representative Dave Brat, in an appearance on National Public Radio, said that the drafters of the bill had relied too much on the existing structure of the Affordable Care Act. “It keeps too many of the bad pieces, which will collide with each other and it will collapse,” he said. “We didn’t run on this ... we voted on the 2015 plan through the House and the Senate, which was a repeal.”
In a commentary published on the Fox News website, Freedom Caucus chair Mark Meadows of North Carolina, writing with Kentucky Sen. Rand Paul, called the proposal “Obamacare-lite” and demanded that Republican leadership revive the “clean repeal” bill that passed both houses of Congress.
“Republicans across America ran on repealing the Big Government takeover of our health care system that is ObamaCare ... We call on Congressional leaders to keep their word to the American people, to push a real repeal of ObamaCare, and to do it now.”
They added, “If anyone tells you there isn’t a plan that can both keep our promises to repeal, and work in a bipartisan, open way for replace, tell them conservatives have a plan to do just that. Now let’s hope our leadership will listen, because it is the only way they’re going to get our votes.”
Criticism from the leaders of the Liberty and Freedom caucuses in the House is significant because between them (there is considerable overlap in membership) they have more than enough members to block the bill’s passage.
Over in the Senate, the proposal’s prospects looked even grimmer. On Twitter Tuesday morning, Sen. Paul predicted the current bill would fail. “The House leadership plan is Obamacare Lite. It will not pass,” he wrote. “Conservatives are not going to take it.”
In the closely divided Senate -- even looking at a bill that will be immune to the filibuster because of its status as a budget reconciliation measure -- Republicans cannot afford to lose more than two votes, and Paul isn’t the only member of the GOP who’s balking.
Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska have all expressed reservations about the bill, saying that they are concerned it will harm low-income residents in their states by, among other things, block-granting Medicaid.
Two other conservative senators, Mike Lee of Utah and Ted Cruz of Texas, have suggested that they won’t support a bill that retains elements of Obamacare.
And it’s a virtual certainty that Republicans won’t be getting any help from Democrats in their effort to destroy the signature domestic policy accomplishment of the most recent Democrat to hold the White House.
Kentucky Congressman John Yarmuth, ranking member of the House Budget Committee, released a blistering statement on Tuesday, saying, “After seven years of campaign promises, Congressional Republicans still do not have a plan to replace the Affordable Care Act. Instead, they’ve released two bills that will lead to higher costs, lower-quality care, and lost coverage for millions of Americans. These proposals will kick millions of Americans off Medicaid and could eventually send deductibles soaring to as high as $30,000 per family, all to pay for massive tax cuts for millionaires and billionaires.”
In a tense press conference on Tuesday, the two architects of the bill asked their colleagues for patience and to approach the debate over the bill in a spirit of cooperation.
Rep. Kevin Brady of Texas, the chairman of the House Ways and Means Committee, challenged the idea that the bill is “Obamacare-lite,” saying it is, in fact, “Obamacare-gone.”
Greg Walden of Oregon, the chair of the House Energy and Commerce Committee, tried to reassure lawmakers worried about the impact the bill would have on the poor. “We will keep our promise to not pull the rug out from anyone, including those on Medicaid.”
Both of their committees are expected to begin considering the legislation Wednesday.