Power struggle over ObamaCare repeal

Who will blink first?

House Republican leaders are in a standoff with conservatives over the Republican ObamaCare replacement bill rapidly moving to the House floor. Unless one side gives ground, the bill appears unable to pass.

Conservatives have a range of objections, and many of them are vowing to vote against the legislation unless substantial changes are made. Leadership is pushing back, saying that lawmakers will ultimately face a take-it-or-leave-it proposition with the bill.

The objecting conservatives are looking for help from President Trump, who they say is more willing to negotiate the bill than Speaker Paul Ryan (R-Wis.) and the rest of House leadership. 

{mosads}Trump has endorsed the House GOP bill, but conservative House Freedom Caucus Chairman Mark Meadows (R-N.C.) said his conversations with the administration indicate they are “still willing to negotiate in good faith; that has been reaffirmed time after time.”

“President Trump isn’t as committed to one policy approach as the leadership team is,” said conservative Rep. Justin Amash (R-Mich.). “The leadership team seems to be very committed to this particular approach. And I think the White House just wants to get something done that will fulfill the promise the president made to repeal and replace.”

House Republican leaders have started referring to their bill as a “binary choice.”

“At the end of the day, members are going to have to make a choice: Do they want to vote with [House Minority Leader] Nancy Pelosi [D-Calif.] or do they want to support President Trump to get that bill to his desk?” House Majority Whip Steve Scalise (R-La.) said Thursday on Fox News.

The conservatives say they won’t back down.

Asked about a leadership assumption they will relent and vote for the bill, Meadows told reporters: “That would be a faulty assumption.”

Conservatives say that leadership doesn’t have the votes to pass the bill without them.

“They’re way short of 216,” said Freedom Caucus member Rep. Raúl Labrador (R-Idaho), referring to the needed number of votes for a majority. (Vacancies in the House bring down the number from the usual 218.)

The conservative Republican Study Committee is pushing an amendment to the bill that would move up the date for freezing ObamaCare’s Medicaid expansion to 2018, instead of 2020. Leadership worries that change would drive away Senate moderates already concerned about repealing the Medicaid expansion.

“That’d be very difficult to do,” House Majority Leader Kevin McCarthy (R-Calif.) said Friday of the Medicaid change.

Meanwhile, conservative Freedom Caucus members on Friday said their main concern now is that the measure does not do enough to drive down healthcare costs. They want the bill to repeal ObamaCare’s “essential health benefits,” which mandate healthcare services that plans must cover, as well as ObamaCare’s insurance regulations, like the ban on discriminating against people with pre-existing conditions.

Conservatives say that if those requirements were repealed, insurers could offer cheaper plans that cover less. Right now, they say, the GOP bill could actually raise premiums.   

“Obviously we’re going to try to make this bill better, where it actually lowers premiums, so at this point, that’s why there’s not 218 votes, or 215 or 216 whatever the magic number is,” Meadows said. “That’s why there’s not enough votes, because at this point, the number one priority, the top priority, you can throw everything away, is driving premiums down. If we don’t do that, we will have failed.” 

The problem, though, is that Senate rules do not appear to allow those items to be repealed through the reconciliation process being used that allows Republicans to bypass a Democratic filibuster in the Senate.

The House committees that wrote the GOP bill say they have been in touch with their Senate counterparts, and their understanding is that essential health benefits cannot be repealed through reconciliation.

House conservatives, though, are frustrated with the Senate rules and say that if need be, the presiding officer of the Senate should simply overrule the Senate parliamentarian, who rules on what can be included.

That would be a drastic step, though, of which many Senate Republicans are likely to be wary. Firebrand Sen. Ted Cruz (R-Texas) is pushing the same approach as House conservatives.

McCarthy acknowledged that the Senate rule limiting reconciliation, known as the Byrd Rule, is “frustrating,” but called for pushing ahead with the legislation anyway.

“It’s unfortunate that in the House we are being contained with all of our ideas based upon a Senate rule and a Byrd rule,” McCarthy said. “I think that’s a frustrating part, but we know where we are, and we’re not going to sit back, because ObamaCare is failing.”

House GOP leadership says that other ideas that won’t pass muster under Senate rules can be passed in a different “phase” or “bucket” of their plan, in separate bills. Some of those bills could even be voted on the same week as the main repeal-and-replace measure, McCarthy said. The administration will also take actions on its own, leadership emphasizes.

But conservatives say putting measures in separate bills is not good enough, because they would need 60 votes in the Senate to pass and therefore are likely to never become law.

“I’m more concerned that whatever needs 60 votes won’t get done,” Meadows said. “Bucket 3, that’s an aspirational bucket.” 

Meadows said he is putting his faith in Trump to negotiate changes, even if Ryan doesn’t want to. 

“Since the president has to sign whatever ultimately becomes law, his willingness to negotiate would certainly carry a lot of weight,” Meadows said.

Jessie Hellmann and Cristina Marcos contributed.