With his reputation on the line as the leading proponent of GOP health care reform, House Speaker Paul Ryan (R-WI) on Sunday predicted victory in the first big test of the GOP’s Obamacare replacement legislation this week.
“We feel like we’re on track and we’re right where we want to be,” Ryan said on Fox News Sunday. “I feel very good about it actually. I feel like it’s exactly where we want to be.”
Ryan and President Trump have been scrambling for days to try to salvage the House GOP plan to replace Obamacare with a more conservative, market-oriented approach and the gradual phasing out of expanded Medicaid coverage in 31 states and the District of Columbia.
While proponents say the GOP plan would eventually provide Americans with access to less expensive, more patient and doctor-centric coverage, the Congressional Budget Office (CBO) projected that 24 million people would lose voluntarily decline coverage under that approach by 2026 and that the replacement coverage would be more expensive in the short run – especially for older and low-income people.
With their party sorely divided between conservatives who complain the plan doesn’t go far enough to dismantle Obamacare's mandates and tax increases and moderates fretting the loss of expanded Medicaid coverage for millions of their constituents, passing the American Health Care Act will be problematic.
Ryan at one point said that his party faced the “binary choice” of backing the GOP replacement plan that he and his lieutenants crafted or sticking with an Obamacare health insurance system that was fast collapsing of its own weight and driving up premiums for millions of Americans.
However, Trump and other White House advisers concluded that some changes would be necessary to quell the revolt by conservatives and placate some moderates and Republican governors.
Now it appears that the House will take up a series of amendments to the original plan when the bill hits the floor this week, probably on Thursday. Those amendments include imposing a work requirement on many able-bodied adult Medicaid beneficiaries, retooling the plan’s refundable tax credit subsidies to provide greater assistance to older and low-income people, and granting states the option of receiving federal Medicaid funding in the future through a block grant program giving them more flexibility in how they spend the money and determine eligibility rules.
Today Ryan insisted that he always had been open to changes to his bill and that his members will finally face that “binary choice” on Thursday when the legislation and a package of “manager’s amendments” are brought to the House floor for a vote.
“The reason I feel so good about this is because the president has become a great closer,” Ryan told Fox News Sunday host Chris Wallace. “He’s the one who has helped to negotiate changes to this bill with members from all over our caucus. We’re still having conversations with our members, we’re making fine-tuning improvements to the bill to reflect people’s concerns, to reflect people’s improvements.”
“I’m very impressed with how the president is helping us close this bill, making the improvements that we’ve been making, getting the votes, so we feel very good where we are,” he added.
Trump was upbeat about the bill’s prospects for passage during a joint press conference on Friday afternoon at the White House with German Chancellor Angela Merkel. He boasted that earlier in the day he had persuaded a dozen conservative House members to back the bill and that it is “going to be passed.”
“It’s coming together beautifully,” Trump said. “We have conservative groups, other groups, everybody wants certain things.”
However, three conservative Republican senators – Rand Paul of Kentucky, Ted Cruz of Texas and Tom Cotton of Arkansas -- all insisted today that the House GOP plan is hopelessly flawed and will not pass through Congress as currently drafted.
“I think there are enough conservatives that do not want Obamacare Lite,” Paul said on ABC’s This Week. “None of us ran on this plan. We ran on repealing Obamacare because it doesn’t work.”
Cruz said during an appearance on the CBS’s Face the Nation that the House bill falls far short of repealing all the Obamacare mandates and taxes, and that “it doesn’t fix the problem” of rising premiums and overall costs to consumers. Cotton agreed with Cruz during an interview on CNN that the House bill will not bring down premiums for people seeking coverage in the private health insurance market.
“I simply think that it’s not going to work to bring down premiums for working Arkansans and working Americans all across the country,” Cotton said. “It’s fixable, but it’s going to take a lot of work, and we need to roll up our sleeves and focus on fixing those problems rather than trying to rush to some arbitrary deadline.”