Ryan huddles with GOP factions on healthcare bill

Leaders of the three main factions in the House Republican Conference huddled Thursday with Speaker Paul Ryan (R-Wis.) to discuss possible changes to the healthcare bill as leaders work to secure enough votes for passage.

No agreement was reached at the gathering, but participants described the discussions as productive. 

Members of the centrist Tuesday Group want to keep a provision in the bill that freezes ObamaCare’s expansion of Medicaid in 2020; conservatives are pushing to move that date to 2018. The centrists also want to increase the amount of the new tax credits in the bill to give more help to low-income people and seniors. 

“We’re talking about what we’re aiming for and what those groups’ … priorities are,” Rep. Tom MacArthur (R-N.J.), a Tuesday Group co-chairman, said about the meeting over breakfast Thursday with Ryan.

Leaders of the far-right Freedom Caucus and conservative 172-member Republican Study Committee also were on hand at the meeting, which is held weekly when Congress is in session.

{mosads}Conservatives say they are confident that Ryan and his leadership team don’t have enough votes to pass the bill unless significant changes are made.

Yet some of the changes that conservatives want appear at odds with the changes being sought by centrists, creating a bind for GOP leadership. 

“I’m not prepared to put a line in the sand, but this bill cannot move forward the way it is,” MacArthur said.

New work requirements for Medicaid were among the possible changes to the bill discussed at the meeting. The rules would require able-bodied, childless Medicaid recipients to show they are either working or seeking work.

“There was a consensus there that, ‘Hey, if you can help us with the [Medicaid] timeline, then we’re able to work with you on the work requirements,’ ” Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, said in an interview. 

Asked if there was any other common ground among the three groups, Walker replied: “Not yet.”

“I think the Speaker is open,” MacArthur said. “He’s discussing these issues with all of these different groups.”

The Freedom Caucus is putting its main focus on bringing down premiums, which it says the current House GOP bill fails to do. The Freedom Caucus wants to repeal ObamaCare’s insurance regulations, such as mandating which services a health plan must cover, arguing those rules drive up costs.

Meadows said Wednesday night that he wants to bring the Tuesday Group on board with an amendment he is working on, but he declined Thursday to share any details about it.

“Negotiations are fragile, but certainly progress is being made,” Meadows told The Hill. “To find a number of common points is not surprising, and yet we must not take our focus off of the ultimate goal: lowering premiums and healthcare costs.”

Rep. Charlie Dent (R-Pa.), a leader of the Tuesday Group, said Thursday that he is unaware of any amendment being worked on with the Freedom Caucus. 

“They have their priorities,” MacArthur said of the Freedom Caucus. “I’m open to some of their priorities. We have our priorities, and I think they are open to some of ours.”

The White House has said it is working with the House on a “manager’s amendment” that would make changes to the bill.

“I think there has to be [a manager’s amendment]” Dent said Thursday. “I know they’re trying to get a sense of where the members are now, and I think a lot of members have expressed concerns like I have on the Medicaid piece and the tax credit piece.” 

Dent and other Tuesday group members warn that the current bill does not provide enough of a tax credit to seniors and low-income people to make insurance affordable.

Dent said the Congressional Budget Office analysis released this week has altered the debate.

“I’ve looked at the charts at different age brackets at different income levels, and there are groups, two in particular, who just aren’t getting as good a deal as they were getting under the Affordable Care Act,” MacArthur, the co-chair with Dent, said. “It’s poorer people and it’s seniors.”

MacArthur said he has proposed “increases” for the tax credits for those two groups, though he declined to say by how much.

Many senators, led by Sen. John Thune (R-S.D.), are also proposing to increase the tax credits for low-income people and seniors. 

Rep. Mark Meadows (R-N.C.) on Wednesday expressed openness to Thune’s change. He called the idea “pragmatic” despite concerns about the tax credit overall.

“I think it’s a prudent thing to take the advanced refundable tax credits and actually give it to more of the working poor,” Meadows said.

Yet the Senate appears broadly resistant to the healthcare legislation, worrying some House lawmakers who don’t want to take a tough vote only to see the bill die in the upper chamber.

“If I hear the Senate say one more time that this bill is dead on arrival, I think my head will explode,” Dent said. “A lot of members here don’t want to walk the plank for a bill that may never be passed by the Senate.”

For the first time, the GOP whip team took the temperature of members on the healthcare bill during floor votes on Wednesday night.

As he left the House floor on Thursday, Majority Leader Kevin McCarthy (R-Calif.) described new energy and momentum behind the bill, noting that it had just cleared the third of four committees.

“I feel good about it,” McCarthy told The Hill. “Look at the momentum … what [members] are saying, what they are doing.”