GOP pushes hard for health care bill
Critics say measure needs ‘extreme vetting’
WASHINGTON — Republican leaders labored to rally a divided party behind their highstakes drive to overhaul the nation’s health care system Wednesday, but faced opposition from pivotal industry groups. House Speaker Paul Ryan praised the proposal as “what good, conservative health care reform looks like” as lawmakers cast Congress’ first votes on the GOP legislation.
Meanwhile, President Donald Trump was seen as facing a crucial first test of his presidency: Can he translate his bully pulpit and popularity with conservative voters into a legislative win? On Wednesday, the president went into dealmaker mode, quietly courting wary conservatives in private meetings and keeping himself somewhat out of the picture.
House leaders wanted to push the measure through two committees — Ways and Means, and Energy and Commerce — by week’s end. While that seemed likely, they hit a torrent of resistance from Democrats who oppose the seven-year GOP effort to unravel former President Barack Obama’s health care law.
Outnumbered Democrats used the panels’ sessions for political messaging Wednesday, futilely offering amendments aimed at preventing the bill from raising deficits, kicking people off coverage or boosting consumers’ out-of-pocket costs. They even tried, unsuccessfully, to insert language pressuring Mr. Trump to release his income tax returns.
The pivotal challenge for Republican leaders was coming not from Democrats but from
rebellion in their own ranks and from potent outside groups. If that upheaval should snowball and crush the legislation, it would be a shattering defeat for Mr. Trump and the GOP, so leaders were hoping passage by both House committees this week would give them momentum.
Just as ominous as GOP unrest, was hostility from three organizations instrumental in the 2010 enactment of Mr. Obama’s overhaul: The American Medical Association, the American Hospital Association and AARP, the nation’s largest advocacy group for older people.
The hospitals — major employers in many districts — wrote lawmakers complaining about the bill’s cuts in Medicaid and other programs and said more uninsured Americans seem likely, adding, “We ask Congress to protect our patients.”
In words aimed at his own recalcitrant colleagues, Mr. Ryan, R-Wis., declared the legislation “is bold and it is long overdue. And it is us fulfilling our promises.” The last was a nod to campaign pledges by Mr. Trump and many GOP congressional candidates.
There were signs of growing White House engagement, and perhaps progress.
Mr. Trump met at the White House late Wednesday with leaders of six conservative groups that have opposed the GOP legislation, and several voiced optimism afterward.
“I’m encouraged that the president indicated they’re pushing to make changes in the bill,” said David McIntosh, head of the Club for Growth, though he provided no specifics.
Underscoring Mr. Trump’s potential impact, Energy and Commerce Chairman Greg Walden, ROre., said of GOP holdouts, “A lot of them, they maybe haven’t felt the inertia that comes with Air Force One landing in their district.”
The legislation would defang Mr. Obama’s requirement that everyone buy insurance — a provision deeply disliked by Republicans — by repealing the tax fines imposed on those who don’t. That penalty has been a stick aimed at pressing healthy people to purchase policies. The bill would replace income-based subsidies Mr. Obama provided with tax credits based more on age, and insurers would charge higher premiums for customers who drop coverage for over two months
The extra billions Washington has sent states to expand the federal-state Medicaid program would begin ending in 2020, and spending on the entire program would be capped at per-patient limits. Around $600 billion in 10year tax boosts that Mr. Obama’s statute imposed on wealthy Americans and others to finance his overhaul would be repealed. Insurers could charge older customers five times more than younger ones instead of the current 3-1 limit, but would still be required to include children up to age 26 in family policies, and they would be barred from imposing annual or lifetime benefit caps.
“We will answer President Trump’s call to action,” said Ways and Means Chairman Kevin Brady, R-Texas, adding later, “Relief is on the way.”
Democrats said the Republicans would yank health coverage from many of the 20 million Americans who gained it under Mr. Obama’s statute, and drive up costs for others because the GOP tax breaks would be skimpier than existing subsidies. And they accused Republicans of hiding bad news by moving ahead without official estimates from the nonpartisan Congressional Budget Office on the bill’s cost to taxpayers and anticipated coverage.
Critics say that is a reckless move.
“Health care is too important, it impacts too many lives, to have a health care bill jammed through in the same manner as President Trump’s immigration order,” said Rep. Lloyd Doggett, D-Texas. “What this bill needs is some extreme vetting.” Mr. Doggett offered an unsuccessful motion for a week’s delay in action by the Ways and Means Committee.
“The bill sabotages the marketplaces where close to 10 million Americans today get coverage and starts a death spiral from which we will never recover,” said Ways and Means’ top Democrat, Richard Neal of Massachusetts.
Indeed, Mr. Trump’s spokesman, Sean Spicer, was seen as going out of his way Wednesday to cast doubt on Congress’ budget experts, perhaps anticipating disappointing results from a coming analysis of the Trump-backed plan to “repeal and replace” Obamacare.
On the Republican side, conservatives in particular were up in arms, saying the tax credits would be too expensive and the phase-out of Mr. Obama’s Medicaid expansion too slow. One conservative group, FreedomWorks, was launching digital and social media ads opposing the legislation, while others like Americans for Prosperity, backed by the wealthy Koch brothers, were working against the legislation.
“It’s way more cost and we’re already bankrupt,” Rep. Dave Brat, R-Va., said of the GOP measure.
Numerous GOP centrists and governors were also antagonistic, worried their states could lose Medicaid payments and face higher costs for hospitals having to treat growing numbers of uninsured people.
Buttressing Republicans, the U.S. Chamber of Commerce was backing the bill. The American Action Network, a political group tied to House GOP leaders, has spent nearly $8 million this year on TV and digital ads supporting the legislation in 75 House districts, mostly held by Republicans.