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GOP Divisions Haunt Health Care Effort

Conservatives think some differences might be irreconcilable

Kentucky Sen. Rand Paul conducts a news conference with members of the House Freedom Caucus at the House Triangle on Tuesday, where they criticized the House GOP’s new health care plan. (Tom Williams/CQ Roll Call)
Kentucky Sen. Rand Paul conducts a news conference with members of the House Freedom Caucus at the House Triangle on Tuesday, where they criticized the House GOP’s new health care plan. (Tom Williams/CQ Roll Call)

The most conservative wings of the Republican Party are pushing their leaders for a separate vote on a bill that would simply repeal the 2010 health care law, despite an acknowledgement that GOP divisions over what to replace the law with might be irreconcilable.

“We have different ideas on replacement,” Sen. Rand Paul of Kentucky told reporters Tuesday as he rallied with members of the House Freedom Caucus and others to criticize the House GOP’s partial repeal and replace legislation. “I think we actually have fundamentally different ideas on replacement — maybe not reconcilable. That’s why I say the best way to get them done is to separate them.”

Paul’s uncertainty about a resolution on replacement stood in contrast to continued optimism from Speaker Paul D. Ryan and other GOP leaders.

“This is the beginning of a legislative process,” Ryan said at a news conference Tuesday. “We’ve got a few weeks. We’ll have 218 [votes] when this thing comes to the floor, I can guarantee you that.”

Paul and House Freedom Caucus founding member Jim Jordan of Ohio announced during a separate news conference Tuesday that they plan to introduce companion legislation in both chambers that would mirror the repeal bill that Congress passed through the budget reconciliation process in 2015 but that President Barack Obama vetoed.

A standalone vote on repeal seems unlikely given that leadership and moderates have objected to moving forward with repeal without a replacement. President Donald Trump has also signaled that repeal without replacement is not an option. 

In a tweet Tuesday evening, Trump said he felt sure that Paul would “come along with the new and great health care program because he knows Obamacare is a disaster.”

Some conservatives have said that repeal and replace votes should occur at the same time and they reiterated that preference Tuesday but said replacement should move in a separate legislative vehicle. If the replacement were to move on its own, it would require 60 votes in the Senate unless it were to advance several months from now in another theoretical budget reconciliation vehicle, which is not subject to 60-vote thresholds.

Given the Republicans’ inability to get 60 votes for a replacement right now, conservatives suggested they focus initially on passing proposals they all agree on, like expanding health savings accounts and allowing interstate shopping and easier formation of association health plans.

If Republicans did just that, there would be no guarantee they’d ever agree on more contentious pieces of the replacement, like how to deal with the current law’s Medicaid expansion and how to ensure low-income individuals can afford to purchase coverage.

“In a democracy, you never have a guarantee of what bills will pass,” Paul said. “You have a guarantee that debate will be open and free and that as many alternatives will be out there, so I think there should be several.”

Jordan said that repealing the health care law “sort of forces the issue to get to the policies that are going to be helpful to Americans.” He added that it may create a greater incentive for Republicans to get on the same page.

House Freedom Caucus Chairman Mark Meadows said he wasn’t worried “that a replacement will never happen as much as I’m concerned at times that repeal will never happen.”

“I’d prefer repeal with a replacement voted on the same day but two separate vehicles. I’ve been consistent,” the North Carolina Republican added.

Asked if a replacement could pass if it didn’t move through reconciliation, Meadows said, “It depends on what’s in it.”

Although it seems unlikely that the more conservative lawmakers will get their way, they do have considerable power if they’re able to hold firm and are willing to vote en bloc against the leadership plan.

Senate Republicans can’t afford to lose more than two GOP votes, and currently, they seem to be lacking at least three given opposition from Paul and conservative Sens. Mike Lee of Utah and Ted Cruz of Texas.

House Republicans can’t lose more than 19 votes, or roughly half of the Freedom Caucus membership. It’s unclear exactly how many Freedom Caucus members are vehemently opposed to the plan. Meadows said they have “serious concerns” about the bill but have not taken a formal position on it. The Freedom Caucus was scheduled to meet Tuesday night to discuss the legislation but Meadows said he doesn’t expect they’ll take a formal position at that meeting.

Meadows said conservatives aren’t advocating a take-it-or-leave-it approach but are rather hoping their concerns will spur negotiations that will result in a better bill. He said those negotiations seemed to begin in earnest Tuesday. Vice President Mike Pence met with Meadows and Jordan at the Capitol Tuesday as part of a series of meetings with GOP lawmakers.

“I’m very hopeful and I believe based on my conversations with the vice president today that it won’t be brought up in the current form that it is,” Meadows said.

Pence told reporters that he and Trump support the bill, which he referred to as the “framework for reform,” but signaled that changes could occur.

“We are certainly open to improvements and recommendations through the legislative process,” the vice president said.

As to the interpretation that meant the bill is open for negotiation, Ryan said, “It’s not that this is open for negotiations. What Mike is trying to describe is we envision three phrases occurring here.”

Phase One is the reconciliation measure currently moving through the House, Ryan said. Phase Two relates to executive actions Health and Human Services Secretary Tom Price can take to “deregulate the market,” and the third phase would see Congress moving additional legislation to “pass those reforms that we believe in” that can’t be done under reconciliation rules, the speaker said.

Bridget Bowman contributed to this report.

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