Obamacare repeal in jeopardy — and not (just) because of Democrats

Eliza Collins
President Trump and his staff host congressional leaders on March 1, 2017. The president and Congress are working together to try and come up with a plan to repeal and replace the Affordable Care Act that doesn't alienate members of their party.

WASHINGTON — Republicans have vowed for years to repeal the Affordable Care Act, but now that they have a GOP president asking for a repeal bill, a massive divide within the party threatens to derail the efforts.

The drama spilled out into the open following Politico's release last week of a health care plan that House Republican leadership was reportedly drafting. The draft plan included at least a half-dozen components that proved toxic for various segments of the Republican Party.

Conservatives in the House are rebelling against the draft bill, and Majority Whip Steve Scalise, R-La., dismissed the legislation as an old draft that GOP leaders never intended to advance. But it is not clear what legislation will get enough support of House Republicans to pass and still have a chance of moving through the much less conservative U.S. Senate.

A core group of conservatives raised alarms on Monday and said they couldn't vote for legislation because it relied on a "refundable tax credit" that would give people money in advance to buy health insurance. In theory, they'd pay the money back when they do their taxes, but conservatives worry it'll end up turning into an entitlement program instead.

Rep. Mark Meadows, R-N.C., said that if Republicans introduced legislation similar to the draft, he wouldn’t vote for it. Meadows is chairman of the House Freedom Caucus, a group of roughly 40 hardline conservatives who are not afraid to break with their party and have threatened to vote as a bloc to halt legislation in the past.

“In order to get it right, if we have to vote against a partial repeal, a partial replacement, we believe that conservatives will understand that vote,” Meadows told USA TODAY.

In this May 17, 2016, file photo, Rep. Mark Meadows, R-N.C. speaks on Capitol Hill.

Meadows was joined by Rep. Mark Walker of North Carolina, the chairman of the Republican Study Committee, a group of about 170 conservatives. Walker said he would advise his members to vote against the draft plan. Sens. Ted Cruz, R-Texas, Rand Paul, R-Ky., and Mike Lee, R-Utah, also said they’d vote "no" on the legislation without changes.

The conservatives have real power when they vote together because Republicans can lose no more than 20 votes in the House and two votes in the Senate and still pass a bill without Democratic support. No Democrats are expected to vote to repeal the health care law, so Republicans need every vote they can get.

Rep. Phil Roe, co-chairman of the GOP Doctor Caucus, had an opposing view of the tax credit. He said if the legislation doesn't include it, people will ask 'what are you going to do about low-income people?' The credit may be their only way to get insurance.

"If you don’t have any money it’s hard to buy something," the Tennessee lawmaker told Bloomberg.

The tax credit is just one of an array of contentious issues for Obamacare replacement.

Freedom Caucus members have said they won’t vote for legislation unless it blocks federal funding for Planned Parenthood, the women’s health care provider that has become a lightning rod for anti-abortion activists. But Sen. Susan Collins, R-Maine, said she doesn’t “think it makes sense” to cut Planned Parenthood funding in the same legislation as the Obamacare repeal. Collins opposed a 2015 repeal bill because it defunded Planned Parenthood.

Collins also expressed concern that the draft legislation would limit the amount of money available to cover people through Medicaid. A key provision of the Affordable Care Act was the offer of federal funding for states that expanded Medicaid coverage to people who were not previously qualified.

“We have some 32 states that took advantage of that part of the ACA and they did so with the reliance that the federal government would pick up most of the cost and I don’t think it’s fair to say to those states 'never mind,'" Collins told reporters Tuesday.

Sen. Susan Collins, R-Maine, speaks to the media in this Feb. 7, 2017, file photo.

Collins' comments about the Medicare expansion echo those of some Republican governors who took the federal funding to expand Medicaid coverage in their states under Obamacare.

“Of course I am concerned,” Nevada Gov. Brian Sandoval told reporters Monday at the end of the National Governors Association’s meeting in Washington. Sandoval said more than 300,000 Nevadans gained coverage through the state’s expansion of Medicaid under the ACA. “That’s been very beneficial to my state, and I want to be sure those individuals can keep their coverage.”

Ohio Gov. John Kasich, who has been vocal about his desire to keep his state's Medicaid funding, went to the White House on Friday to make his pitch. Kasich said Trump "listened very carefully to what I had to say about it and had a very positive response," according to the Associated Press.

In Trump’s speech to Congress on Tuesday night, he said “we should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out." But he offered no details about what those resources would be.

Trump's vague comments on the Medicaid expansion are illustrative of a larger issue within the party where lawmakers are trying to figure out what the president's intentions are.

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There's increasing pressure on Republican leadership to come together on a plan.

House Speaker Paul Ryan's, R-Wis., spokeswoman AshLee Strong said that there's a plan from late last year, but it wasn't clear what replacement details were available for the plan.

"We put forward a bottom up healthcare plan last year and members ran on that plan throughout the campaign. We're now following through on that plan and the promises we made to our constituents," Strong said.

Senate Majority Leader Mitch McConnell, R-Ky., arranged a meeting for Republican members Wednesday to discuss the path forward on Obamacare repeal. House Ways and Means Chairman Kevin Brady, R-Texas, and Energy and Commerce Chairman Greg Walden, R-Ore., were invited to explain the plan the House is working on. But McConnell’s aides insisted the meeting was nothing new and that senators meet regularly to discuss health care. Some Republican lawmakers also met with the president Wednesday, but the White House offered no details about that conversation.

“This is an incredibly difficult situation that the congressional Republicans are in," said Mark Harkins, a senior fellow at the Government Affairs Institute at Georgetown University. It will be "practically impossible to get anything passed through both bodies, especially in the next six weeks, before the April recess,” he said.

When that recess arrives, Republicans, who already had to face a stream of angry voters during town halls last week, will again be going home to talk with constituents.

Virginia Rep. Dave Brat — who is a member of the Freedom Caucus and has said he won’t vote for the leaked plan — said he wants more information from Republican leadership to be able to tell his constituents what’s going on.

“There are too many members of Congress that don’t know the status of 'where we are. So it’s very hard to know what’s coming and if we’re going to do a repeal and replace,” Brat said. “We need more than bullet points, right? We’re all going home having town halls with people putting up red cards in the back of the room yelling at us, so we need some answers.”

Contributing: Maureen Groppe