House Speaker Paul D. Ryan (R-Wis.) sought on Wednesday to stem the tide of resistance to a Republican proposal to revise the Affordable Care Act, calling his plan a “conservative wish list” that will deliver on many years of GOP campaign promises to reform the health care system.
“I have no doubt we’ll pass this because we’re going to keep our promises,” Ryan said at a news conference following 24 hours of conservative backlash against the bill.
“This is a monumental, exciting conservative reform,” Ryan said. “I’ve been working on this for 20 years. This is exciting. This is what we’ve been dreaming about doing.”
Lawmakers gathered in two House committees Wednesday to begin working on the legislation, which has also received pushback from moderates in the Senate and key health -care industry stakeholders since it was released on Monday.
The most imminent and serious threat to the plan was the criticism from conservative lawmakers and powerful outside groups that argue that the draft is nothing more than “Obamacare Lite,” a disparaging reference to the former president’s signature 2010 domestic achievement.
Ryan played down the conservative opposition, calling it an outgrowth of the GOP’s new grasp on power.
“I think what we’re seeing is, we’re going through the inevitable growing pains of being an opposition party to being a governing party,” he said. “It’s a new feel, a new system for people.”
While the skeptical conservative lawmakers do not represent a majority of Republicans in either chamber of Congress, there could be enough of them to scuttle any health-care bill they oppose — and several said Tuesday they intend to use that leverage to force major changes to the measures.
President Trump said at a meeting with House Republicans on Tuesday that he would work with them to secure passage of their plan despite conservative opposition.
According to several attendees, Trump made clear that he wants the House bill to be approved quickly and land on his desk largely intact. He pledged to become personally involved in persuading skeptical lawmakers and warned that failing to pass the legislation would result in trouble at the ballot box for Republicans who pledged to repeal and replace Obamacare.
The White House has already spent several days targeting skeptical conservatives in a behind-the-scenes “charm offensive,” Sen. Rand Paul (R-Ky.) said Wednesday morning.
“Every conservative that’s come out publicly opposed to this has been called by the White House and is being cajoled and wooed by the White House to give in,” Paul said during an interview with MSNBC’s “Morning Joe.”
“But if conservatives stick together … we will have a force and a negotiation,” he said. “Because I don’t think they have the numbers to pass this at this point.”
Trump had specifically called out Paul — who has emerged as the bill’s chief skeptic — with a tweet Tuesday evening: “I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!”
The margin of error is slim for House and Senate GOP leaders — in the House, Ryan can afford to lose only 21 GOP lawmakers. In the Senate — which is using an unusual parliamentary procedure that requires only a simple majority for legislation to be approved — Majority Leader Mitch McConnell (R-Ky.) must persuade all but two Republicans to support the plan. Republicans have 52 seats in the Senate, and no Democrats are expected to back the overhaul in either chamber.
One of the most unusual aspects of Wednesday’s committee work is that lawmakers are beginning to vote on the two health-care bills without a “score” from the Congressional Budget Office, assessing their implications for not only the budget but the nation’s insurance market.
Democrats, consumer groups and some conservatives have argued that such an analysis — which would indicate how many Americans would gain or lose coverage under the new plan — should play a key role in lawmakers’ decision-making.
White House Budget Director Mick Mulvaney downplayed worries about the missing cost estimate, predicting it would arrive on Monday and noting that under a special budget procedure known as reconciliation, a bill cannot increase the federal deficit after 10 years.
The House Republican plan is being considered under reconciliation.
“We all know [the bill] is going to score positive in helping out the deficit, to spending less money, another thing that conservatives should be supportive of,” Mulvaney said on MSNBC. “So I hear all the talk about the CBO score. The only question about the CBO: is it going to be really good or is it going to be great when that number finally comes out?”
Republican senators have complained the process is already moving too quickly under the House’s plan for two committees to begin considering the health care bill on Wednesday.
“I don’t think we need to introduce legislation on Monday and have one chance to amend it on Wednesday,” Sen. Tom Cotton (R-Ark.) said on “Morning Joe.”
“I want to get it right. I don’t want to get it fast. And the Senate certainly will not just be jammed with whatever the House sends over here,” he said.
Several Republican senators privately groused following late-afternoon votes Tuesday that they felt rushed by their GOP colleagues in the House and by Trump, who they said does not fully grasp the Senate’s slower pace or its concerns.
“If [passage] takes months or a year, so be it,” said one Republican senator, who spoke on the condition of anonymity because negotiations are ongoing.
The senators also expressed skepticism that key White House officials with deep ties to Congress’s conservative wing would eventually be able to lock up the votes for the current plan. Instead, they said there is confusion over who is managing the process and which administration figures, if any, have power to sway Trump on the issue.
The Senate could pose a problem for Republican leaders, with Sens. Paul, Ted Cruz (R-Tex.) and Mike Lee (R-Utah) opposing the House draft. Paul and Rep. Jim Jordan (R-Ohio) said Tuesday that they would reintroduce the 2015 legislation that passed the Republican-led Congress and that ultimately was vetoed by President Barack Obama. Nonpartisan congressional budget analysts estimated that bill would cause millions of Americans to lose their health insurance coverage almost immediately.
Four Senate Republicans have expressed worries about the plan’s possible impact on lower-income people who received Medicaid coverage through the ACA’s expansion of that program. The senators are split on what proposals would meet their standards, but none is likely to support the course of action favored by many conservatives.
Ryan has outlined three phases in which health-care reform would be achieved: first, via the special budget procedure known as reconciliation, of which the current measures are a part; then, through regulations at the Department of Health and Human Services; and finally, the passage of other bills that will need bigger backing and could include the ability to buy insurance across state lines, a priority for conservatives.
This has not satisfied the roughly 30-member hard-line House Freedom Caucus.
Other Republican lawmakers have found themselves under pressure from conservative activist groups such as Heritage Action for America, the Club for Growth and FreedomWorks, which came out strongly against the leadership proposal Tuesday. Those groups are adept at riling up the GOP base against Republican leaders and could cause significant headaches for Ryan.
“If this warmed-over substitute for government-run health care remains unchanged, the Club for Growth will key vote against it,” said the group’s president, David McIntosh, referring to a process in which lawmakers are graded on their votes, the better to use them as ammunition on the campaign trail.
At least one of the country’s biggest health-care groups also weighed in with caution on the proposal. The American Hospital Association, representing 5,000 hospitals and other health-care groups, argued that the process should not advance until the CBO provides a cost estimate.