Ryan 'Listening' to Concerns as Obamacare Repeal Advances to Next Level

House members in charge of revising the bill have mixed feelings about how the process went down. Yet it's not clear that there are enough votes to pass the bill in the House and send it to the Senate, where it will face a fresh set of obstacles.

Along with their letter to GOP House Speaker Paul Ryan of Wisconsin and Republican Senate Majority Leader Mitch McConnell of Kentucky, the governors offered a nine-page proposal they say would reform the Medicaid entitlement, while addressing issues of equity for states that expanded Medicaid under the Affordable Care Act, along with states that didn't.

Ryan and his GOP lieutenants can afford to lose no more than 21 votes in the chamber, presuming all Democrats vote against the bill.

According to a report Monday in Politico, Steve Bannon, chief strategist to the president, was working over the weekend with Rep. Mark Meadows, head of the House Freedom Caucus, and other White House officials to find ways to mollify conservatives now blocking the bill they call "Obamacare Lite". Only one, Rep. Jim Jordan - a member of the House Freedom Caucus - remained opposed. "If we don't get this through, the goal of repealing Obamacare and instituting a system that will be patient-centered will be unbelievably hard", Sean Spicer said Tuesday. This week, the Congressional Budget Office (CBO) said 24 million people could be uninsured by 2026.

In an extreme example under the current bill, the premium for a 64-year-old making $26,500, after factoring in financial assistance, would rise from $1,700 to $14,600 under the GOP plan.

Republican members have been assured that the current House bill is on track and being reworked to include the option for states to impose work requirements for able-bodied adults who are on Medicaid, something the RSC has been lobbying for.

But that support isn't universal among Republicans.

"We agree and share in these important objectives", the governors wrote. "At this particular point, I think it's incumbent upon us to realize that we have one boss, and that boss is back home, for me, in North Carolina".

House conservatives say they are negotiating some changes directly with the White House, cutting out House GOP leaders, while rebellious GOP senators were stoking the opposition.

In addition to the Medicaid agreement with the RSC, the White House and House leaders are also eyeing increasing the tax credits in the bill, something that could bring centrists on board.

"My job is to move bills through the House", he said at a press conference. "It's going to be passed I believe".

For now, it's Mr. Ryan's fight to win, as House conservatives demand changes.

"They won't have the votes unless they change it" further, Meadows said.

"The proposed changes to the individual insurance market would be modestly credit negative for healthcare companies over the next year or so, as some people choose to forgo health insurance", said Moody's Senior Vice President Jessica Gladstone in a statement. "He is a constructive force to help us get to a resolution so that we get consensus on how to repeal and replace Obamacare". "I do not believe the AHCA now does that".

The president is reportedly willing to tweak the bill to help reassure those conservatives.

"That's a sign of presidential leadership", Barr said.

"It is dead", he said. "It's not there", Trump said.

A proposal from the governors, however, would preserve the expansion and make it available to other states that didn't expand it under ObamaCare. The current House Republican bill would wind down the current Medicaid expansion starting in 2020, and there are proposals to start a wind-down sooner.

"It provides nearly no new flexibility for states, does not ensure the resources necessary to make sure no one is left out and shifts significant new costs to states", the governors wrote in the letter.

Instead, the four governors urged the two leaders to consider their alternative healthcare plan that would allow each state "to pursue Medicaid transformation in its own way".

  • Leroy Wright