A House vote on the American Health Care Act – the GOP replacement for the Affordable Care Act, or Obamacare – is slated for Thursday. But some conservatives are wary – they worry the bill will leave too many people uninsured. Others say it doesn’t go far enough in repealing the original law.
The bill needs 216 votes to pass the House. None of the 193 Democrats have said they’ll vote for the bill and the House currently has five vacancies. So if 22 of the 237 Republicans withhold their support, the bill won’t pass.
Kevin Diaz, Washington correspondent for the Houston Chronicle, surveyed members of the Texas GOP House delegation Tuesday. Only about a dozen responded, with six saying they remain uncommitted either way.
“It’s always hard to commit right up to on the 11th hour of a vote because once you say ‘Yes,’ you’ve given up any bargaining leverage that you may otherwise have,” Diaz says. “Some of them may be leaning ‘Yes’ but they may be saying publicly they’re not on board yet.”
Not so, for Rep. Louie Gohmert (R-Tyler), a member of the conservative Freedom Caucus. He’s said he doesn’t support the bill as is, but if there were a few more changes, he might consider signing on.
“For Gohmert and a lot of the hard-right conservatives, they want the entire regulatory framework of Obamacare gone,” Diaz says. “Specifically, they want the insurance mandates gone. Now they don’t always use this language, but included in that is getting rid of the protections for preexisting conditions – which are pretty popular with the public and, frankly, with a lot of moderate and centrist Republicans. It’s a pretty deep divide.”
Republicans dislike the Affordable Care Act’s individual mandate that sets a tax penalty for people without insurance coverage. But the American Health Care Act would replace the tax penalty with a surcharge for people dropping coverage and then re-enrolling in healthcare. So some Republicans see that as a continuance of mandates.
“They’re pitching [the bill] as a three-phase process,” Diaz says. “The first phase is just what they can get by through the Senate without a Democratic filibuster – so that shackles them somewhat. And that’s what they’re asking for forbearance on with their conservative counterparts. It’s ‘Trust us, we’re just doing what we can now and we’ll get to the real heavy lifting later.'”
But that’s not what Republicans ran their campaigns on, Diaz says. They ran on full repeal of Obamacare. Some conservatives are saying the American Health Care Act as is now doesn’t quite do the trick.
President Donald Trump was on Capitol Hill Tuesday, giving the hard sell on the bill.
“This is Donald Trump as advertised. This is the closer, the deal-maker who we all thought that was going to be the positive side of Donald Trump,” Diaz says. “But in the House, in the end, they’re answerable to their constituents. Republicans from uber-conservative districts aren’t going to go back and say ‘Yeah, I compromised because Donald Trump asked me to.”
A lot of conservatives were deeply suspicious of Trump during his campaign, Diaz says.
“They didn’t think he was a real limited, small government conservative when he was running,” he says.
One of the crafters of the legislation is Texan and House Ways and Means Chairman Rep. Kevin Brady (R-Woodlands). He laid out some changes to the bill this week hoping to get more of his colleagues on board, which Diaz says is a classic maneuver in Congress – adding sweeteners at the end to try and bring over recalcitrant holdouts.
“It’s really threading the needle,” he says. “He is trying to throw a few bones out there for the conservatives.”
His changes include getting rid of some of the Affordable Care Act taxes and rolling back the Medicaid expansions faster. He has to balance that with placating centrists and moderates who are worried about throwing people off the insurance rolls.
“He also threw in some more money to help people buy health insurance,” Diaz says. “So he’s trying to placate both sides. But the more you give to one side, the more you lose on the other – so that’s the box that they’re in.”
Diaz says he’s not a betting man, but if he had to predict how the vote will turn out, he says it doesn’t look good for the Republicans.
“I would not be surprised if they canceled this vote,” he says. “One thing everybody has to understand is you don’t hold votes in Congress unless you’re sure you’re going to win them. So if they cancel tonight that means they didn’t get enough votes.”
The New York Times put together this easy-to-follow chart of the changes between the Affordable Care Act and the American Health Care Act:
Written by Beth Cortez-Neavel.