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House GOP Moving Toward Health Care Markup Despite Unresolved Concerns

Republicans say it’s a way to break through the impasse

House Republicans plan to begin moving a health care bill through the legislative process despite lingering concerns among many members. (Tom Williams/CQ Roll Call)
House Republicans plan to begin moving a health care bill through the legislative process despite lingering concerns among many members. (Tom Williams/CQ Roll Call)

House Republicans hope to start marking up a bill to repeal and partially replace the 2010 health care law next week, despite a litany of concerns about the plan. But proceeding with the legislative process is one way members say they can break through the impasse. 

Lawmakers with concerns about the plan range from conservatives, who view the refundable tax credits that are designed to help people purchase coverage in the private market as the creation of a new entitlement program, to moderates from states that have expanded Medicaid, who worry the plan won’t provide enough funding needed to sustain coverage provided through that program.

The concerns come on top of lingering questions about how much the GOP plan would cost, how it will be paid for and when the repeal and replacement pieces would take effect.

“We’re looking to get to a ‘yes.’ We’re not looking to be adversarial,” Republican Study Committee Chairman Mark Walker told reporters Thursday after a GOP conference meeting on the repeal and replacement effort. “But there are some of those questions that have to be answered.”

The North Carolina Republican said Monday that he and several RSC members could not support the draft GOP bill that was leaked to the press last week. After the conservative caucus met Wednesday, Walker said they’d come to an understanding that the plan would center around tax credits to help subsidize the cost of insurance, and not tax deductions as an RSC replacement plan proposed. But he said they still had questions about the implementation and cost.

Members of the House Ways and Means and Energy and Commerce committees that have jurisdiction over the repeal and replace measure say they’ve been working to address members’ concerns and are hoping to move forward with separate markups next week.

If those committees report out their portions next week, the Budget Committee will mark up the reconciliation measure the following week, according to the panel’s chairwoman, Rep. Diane Black of Tennessee.

Ways and Means member Kristi Noem said the goal is to get the bill through the House and to the Senate in the “next couple weeks.”

Asked if the committees need to keep the process moving regardless of whether the whole conference is on board, the South Dakota Republican said, “I think possibly.”

Proceeding with the legislative process could help resolve some of the concerns but it will likely open the door to more, as additional details of the plan are revealed.

Energy and Commerce member Chris Collins said moving a “consensus” bill through the committee will likely help alleviate some of the unease.

“That’s what we have to do, sometimes take tough votes, signal to our conference that the committee you’ve entrusted with this jurisdiction has made this decision and we move it forward,” the New York Republican said.

“Anytime the committee of jurisdiction, especially on the Republican side, moves more or less with overwhelming majorities, … it does signal to the conference, ‘We’ve studied the issue. We’ve explored all the things we can. This is our best effort. We hope you support it,’” he added.

While the support of the committees of jurisdictions is needed to help the legislation move forward, some Republicans have been looking to President Donald Trump to endorse a specific plan. The president outlined some health care replacement principles in his address to Congress on Tuesday that GOP leaders saw as as sign that he is in sync with them, but some conservatives said they didn’t hear anything in the address that specifically backed the House Republican plan.

“If the president comes out and says, ‘This is the exact plan, this is the way we’re going,’ obviously, that’s going to impact it,” Walker said. “If you look at our districts, most of us have 90 percent of our Republican Party or 100 percent behind the president, which we are as well. So his influence on this is not something that’s nominal.”

During Thursday’s conference meeting, Speaker Paul D. Ryan told members that Trump supports the House GOP’s plan, according to Oklahoma Republican Rep. Tom Cole.

This was confirmed by a source in the room, who said also Ryan noted that Trump believes repeal only is not an option. Conservatives had been calling for the House to move the 2015 reconciliation bill for repeal and to work on the replacement portions in separate legislation.

House Ways and Means Chairman Kevin Brady only said after Thursday’s meeting that the conversation was “positive” and “moving forward” but he did not reveal details about the plan being discussed.

That lack of details appears to be a point of frustration among members. The committees have not yet provided legislative text and have only allowed members of their panels to review the draft plan in a private room to avoid additional leaks until the legislation is finalized.

Some lawmakers said that while they understand the need for caution and aren’t worried the bill will be kept under lock and key for long, they would like to see the bill as soon as possible.

“They need to release the bill, so we can actually study it,” Freedom Caucus member Raúl R. Labrador of Idaho said, when asked what needs to happen for Republicans to start working through their differences.

Ryan has said little publicly to address his members’ concerns. Instead, the speaker has insisted that the House, Senate and White House are all working off the same plan, which has been developed from the blueprint that House Republicans ran on during the 2016 campaign.

“I am perfectly confident that when it’s all said and done we’re going to unify because we all — every Republican — ran on repealing and replacing,” Ryan told reporters Thursday. “And we’re going to keep our promises.”

Rema Rahman contributed to this report.

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