Northwest Arkansas Democrat-Gazette
Ryan says change coming to health care proposal
WASHINGTON — House Speaker Paul Ryan said Wednesday that his health care proposal must change to pass the House, marking a significant retreat from his earlier position that the carefully crafted legislation would fail if altered.
The shift came after a private meeting of House Republicans from which Ryan, R-Wis., emerged to tell reporters that his proposal to revise the Patient Protection and Affordable Care Act would “incorporate feedback” from the rank and file. Ryan attributed the change of strategy to the effect of an analysis issued Monday by the Congressional Budget Office, which prompted a fresh round of criticism of the proposal.
Ryan backed away Wednesday from his previous rhetoric of calling the measure’s fate a “binary choice” for Republican lawmakers.
“Now that we have our score … we can make some necessary improvements and refinements to the bill,” he said, referring to the office’s estimate of the effect on the number of those covered by health insurance and what the GOP proposal would cost.
Ryan did not detail what changes are under consideration.
Vice President Mike Pence also spoke to House Republicans in the meeting, acknowledging that changes to the legislation — which heads to the House Budget Committee for approval today — are in the works. President Donald Trump has offered his support for Ryan’s measure, while still meeting with conservative lawmakers who have expressed serious doubts about the plan.
“This president is ready to put the full weight of his bully pulpit and all of his tools” behind the bill, Pence told Republicans, according to Rep. Kevin Cramer, R-N.D. “It was very important for us to hear that, because there are a lot of people who need that shoring up.”
Pence told conservatives that the plan was still under negotiation at a private lunch meeting of the Republican Study Committee, a large caucus of conservative House Republicans, according to several attendees.
“As he said, it’s not often that we get an opportunity to undo such a big piece of legislation that had negative consequences on the American people,” said Rep. Markwayne Mullin, R-Okla., paraphrasing Pence’s message. “He’s open to make improvements. … Anything that can get 218 votes and make the bill better, we’re all about it.”
The legislation faces an important test today, when the House Budget Committee meets to consider the legislation and advance it to the House floor. The committee cannot directly amend the bill but can make nonbinding recommendations. Any substantive changes would be made by the House Rules Committee, which controls how the bill is presented and debated on the floor.
The meetings on Capitol Hill came as the Centers for Medicare and Medicaid Services reported Wednesday that more than 12 million people have enrolled for coverage this year under the Affordable Care Act.
The official national figure of 12.2 million excludes 765,000 people signed up under a related law from President Barack Obama’s era used by New York and Minnesota.
The latest government sign-up numbers missed Obama’s target of 13.8 million people for 2017. The figures represent initial enrollment.
Experts said the report undercuts Republican claims that repealing the health law is crucial because its insurance markets are teetering toward collapse.
“While there’s a big debate in Washington about the future of the Affordable Care Act, the law remains in place for now and is covering millions of people,” said the nonpartisan Kaiser Family Foundation’s Larry Levitt.
Despite the meetings with Pence, Republican opponents still abounded. Conservatives were unhappy the measure doesn’t erase enough of Obama’s law while, at the other end of the party’s spectrum, moderates were upset the bill would strip millions of health coverage.
“Oh heck, yes,” said one conservative leader, Rep. Jim Jordan, R-Ohio, asked if the GOP legislation needed changes to win his support.
Conservatives want to end Obama’s expansion of Medicaid to 11 million additional low-income people next year, not in 2020 as the bill proposes. They say a GOP-proposed tax credit to help people pay medical costs is too generous, and they want to terminate all of Obama’s insurance requirements, including mandatory coverage of specified services like drug counseling.
Underscoring the pushpull problem GOP leaders face in winning votes, moderates feel the tax credits are too stingy, especially for low earners and older people. They oppose accelerating the phaseout of the Medicaid expansion and are unhappy with long-term cuts the measure would make to the entire program.
Terminating the Medicaid expansion in 2020 and not 2018 “is sacrosanct to me,” said Rep. Tom MacArthur, R-N.J.
In an earlier interview Wednesday, Ryan countered reports that White House support for the bill might be softening under criticism from Trump’s allies. He said he had spoken to Chief of Staff Reince Priebus and chief strategist Steve Bannon about it “a number of times” and noted that Trump has brought lawmakers to the White House to make the case for the legislation.
“We are on the same page as the White House,” Ryan told conservative radio host Laura Ingraham. “I think there are those who would love to wedge us for one reason or another, but that’s just not the case.”