­ObamaCare showdown set in Budget Committee

Republican leaders have portrayed a united front in their effort to overhaul ­ObamaCare, but the cracks are likely to show on Thursday when the House Budget Committee marks up the GOP’s healthcare legislation.

House conservatives, many of them members of the Freedom Caucus, have hammered the American Health Care Act as a milder continuation of former President Obama’s signature healthcare law, railing against their own leadership team for retreating on a promise they’ve been making to voters for the last seven years to repeal it.

Rep. Dave Brat (R-Va.), who’s both the loudest of the House critics and a member of the Budget Committee, told The Hill he will vote against the bill Thursday unless some planned administrative actions to eliminate insurance regulations — now part of the GOP’s second phase of ­ObamaCare replacement — are tucked inside the GOP bill.

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“The fundamental flaw from our point of view is there are too many of the ­ObamaCare elements in here that have failed,” Brat said.

Brat’s opposition would mark the first official act of defiance against a Republican package being pushed by President Trump, Speaker Paul Ryan (R-Wis.) and other GOP leaders. The proposal last week sailed through two other committees — Ways and Means and Energy and Commerce — with every Republican on board.

But Brat may not be alone. Several other conservatives on the Budget panel have also been critical of the Republicans’ proposal, including Reps. Mark Sanford (S.C.) and Gary Palmer (Ala.), both members of the Freedom Caucus.

Adding to the leadership’s headaches, Sen. Rand Paul (R-Ky.), a vociferous opponent of the House replacement bill, is pressing Republicans on the panel to oppose the legislation during Thursday’s markup. If the bill passes with unanimous GOP support, he fears, it will convince Ryan and other Republican leaders that they won’t have to negotiate with conservatives on changes.

Republican leaders say they’re certain the proposal will pass through the Budget panel, with Chairwoman Diane Black (R-Tenn.) predicting as much on Wednesday. 

“I am confident this bill is going to come out of Budget,” she said in an interview with MSNBC.

But leadership doesn’t have much room for error. With 22 Republicans and 14 Democrats on the committee, GOP leaders can afford only three defections. A fourth, and the bill stalls without Democrats lifting a finger. 

Rep. John Yarmuth (Ky.), the top Democrat on the Budget Committee, said Wednesday that panel Republicans are grumbling about the GOP’s proposal, forecasting a tight vote on Thursday. 

Complicating the math for the Republicans, he noted, is the Congressional Budget Office’s (CBO) analysis of the bill, released Monday, which predicted that 24 million fewer people would have health insurance by 2026 if the proposal becomes law.

“I think it’s going to be a close call,” Yarmuth said during a press briefing in the Capitol. “There are a number of Republicans who I’ve spoken to who have very serious problems with the legislation and understand the predicament that … they find themselves in.

“That doesn’t necessarily mean they’ll vote against it,” Yarmuth emphasized. “I think they’ll be under a lot of pressure to move the bill out of Budget and off to the Rules Committee.”

Black on Wednesday forecast a strategy she may tap to entice wary Republicans: The committee, she said, could adopt “recommendations” for future actions favored by the conservatives. While nonbinding, they could mollify the critics enough to win their vote.

Thursday’s vote arrives as Ryan and other GOP leaders are struggling to thread a needle as they try to dismantle the central elements of the Democrats’ 2010 healthcare overhaul — a central promise of Trump’s campaign. 

Ryan on Wednesday described Trump as being “all in” on passing the legislation. 

“We’re working hand in glove with the White House. We meet with them daily, we’ve worked on this bill together, we jointly drafted this legislation — House, Senate and White House,” Ryan said on CNN.

“They are fully invested on this.” 

Aside from the conservative critics who have dubbed the bill “­ObamaCare lite,” centrist Republicans are voicing concerns that constituents currently covered under ­ObamaCare’s insurance subsidies and Medicaid expansion would lose coverage under the bill  — fears only exacerbated by the CBO report. 

Democratic leaders, who have suffered politically for championing ­ObamaCare, are only too happy to highlight the Republicans’ struggles now that the tides have turned. 

Rep. Linda Sánchez (Calif.), vice chairwoman of the House Democratic Caucus, accused the “mean-spirited” Republicans of “putting lives at risk” by pushing forward with their replacement plan, rather than simply fixing the problems with ­ObamaCare. 

“If their bill fails, it’s basically akin to saying, ‘We didn’t have anything better; our bill sucked,’ ” she said.