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Key Conservatives Come Around on GOP Health Plan

Republican Study Committee leaders sign off, but Freedom Caucus still wary

Rep. Mark Walker, R-N.C. (Bill Clark/CQ Roll Call)
Rep. Mark Walker, R-N.C. (Bill Clark/CQ Roll Call)


Several key Republicans on Friday endorsed the health care overhaul bill crafted by GOP leaders and the White House, saying President Donald Trump had agreed to changes they favored minutes earlier during an Oval Office meeting. With a vote on the so-called American Health Care Act scheduled for this coming Thursday in the House, the news was welcomed by supporters of repealing and replacing the 2010 health care law.

Just over a dozen Republican Study Committee members told reporters outside the West Wing that leadership of the conservative caucus is now a “positive yes” after the president signed off on Medicaid language on block grants for states and to change work requirements.

The endorsement of the measure comes from the RSC’s Steering Committee, not its full membership, which comprises roughly two-thirds of the GOP conference.

All but one of the 17 RSC Steering Committee members (not counting four ex-officio members) have committed to voting yes on the bill, eight or nine of whom had shifted from a no or leaning no because of the Medicaid changes, RSC Chairman Mark Walker told reporters at the Capitol.

Ohio Republican Jim Jordan, a former RSC chairman who later went on to help form and chair the hard-right House Freedom Caucus, remains a no vote.

The votes Trump and Speaker Paul D. Ryan, R-Wis., secured on Friday move them one step closer to locking in the 216 GOP votes they will need on the floor to send the measure to the Senate. (Because of five House vacancies, the threshold for majority support is lower than the usual 218.)

The changes Trump signed onto would give states more flexibility by allowing them the option to take Medicaid funding as a block grant or a per-capita payment, said a White House official. It would also impose a work requirement for able-bodied adults that do not have children who are enrolled in the Medicaid program, the official said.

House Majority Whip Steve Scalise said the language would allow states to decide whether to impose the work requirement but provide incentives for them to do so.

“Those were two changes that were significant reforms and actually add significantly to our vote count, including a member who voted ‘no’ yesterday in committee who is now a ‘yes,’” the Louisiana Republican told reporters at the Capitol. He was referring to Alabama Republican Gary Palmer, a member of both the RSC Steering Committee and the Freedom Caucus who voted no during the Budget Committee markup yesterday.

Scalise sounded optimistic but avoided saying that GOP leaders have firmed up 216 votes, noting that discussion are still taking place about other potential changes.

House Freedom Caucus Chairman Mark Meadows said his whip count, which he conducts of Freedom Caucus members and others outside the caucus who have similar views, had 40 members as a “no” that he believes will not be swayed by the changes under discussion.

At the White House earlier, Scalise described Trump has being heavily involved for the last few weeks in negotiating possible changes with House Republican factions, and was eager to hear ideas from each group, including the RSC.

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“One of the things that President Trump said today: He asked every member, with these changes, to vote for the bill,” Scalise, clad in a green tie on St. Patrick’s Day, said under a Friday morning sun outside the West Wing. “And President Trump himself committed that he is all in, 100 percent, in for this bill.

“And all of these members were in various places — some for, some ‘undecided,’ some even ‘against’ the bill initially — who with all of these changes that President Trump brought to us are now a ‘yes’ on this bill,” the House majority whip said.

Walker signaled additional changes could be coming, telling reporters at the White House that Republicans and Trump will be “trying to refine this to the very last moment to make it the very best for the American people.”

The North Carolina Republican and former pastor strongly endorsed the Medicaid work requirement change, saying: “As a person of faith, I think God creates every boy and girl, man and women with unique skills and talents. We want the government to enhance that, to flourish that, not to stymie it.”

Walker told reporters at the Capitol later that he would prefer the work requirement to be mandatory instead of optional, although he said he would vote yes either way.

RSC member Marsha Blackburn of Tennessee called the block grants “vital” for states.

“They’re important,” Blackburn said. “The states have told us they want the flexibility. They have the ability to deliver a better health care product, and to do more with the money they have for their constituents.”

Scalise and the RSC members declined to say whether they will support whatever changes the other chamber might make to the bill. But he told reporters many Republicans “want to give the Senate that opportunity.”

“And these actions today by President Trump, working with our members for weeks to get to this point, gives us the best chance to give the Senate that bill. If they want to make additional changes, that’s called the legislative process, and we would encourage their ideas.”

Another way the White House and House GOP leaders might attract more conservative votes is to move the bill’s current 2020 date for rolling back the 2010 health law’s Medicaid expansion. Friday’s meeting did not cover that possibility, Scalise said.

Members at the Capitol said they believe that change, which had been heavily pushed by the RSC but opposed by moderates, is off the table.

“I think a lot of us would like to pull that back from 2020 but I think more and more of us realize that that’s just not politically doable,” Alabama Republican Rep. Bradley Byrne said.

Byrne, a RSC Steering Committee member who did not attend the White House meeting, said he was a “yes” on the bill last week but other members have more recently moved to that position.

“I think that the support has built for it dramatically over the last 24 hours,” he said, citing the Medicaid changes.

While RSC leaders were at the White House, House Republicans huddled with Health and Human Services Secretary Tom Price in the Capitol. Price discussed some of the health care changes he can make administratively as part of phase two of the GOP plan.

But members leaving the conference meeting were more focused on changes that will be made to the reconciliation measure House leaders scheduled for Thursday’s vote, which is phase one of the effort.

In addition to the Medicaid changes, House GOP leaders are considering adjusting the refundable tax credits to make them more generous to older adults near the retirement age.

“We’re looking at all the options that can help states lower the costs for low-income and for the early retirees that usually have higher medical costs,” Ways and Means Chairman Kevin Brady of Texas told reporters, noting there are “no decisions yet on how best to do that.”

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Brady said they have not made a decision on whether to wait for the Congressional Budget Office to score any changes to the bill before bringing it to the floor.

Pennsylvania Republican Charlie Dent, co-chair of the moderate Tuesday Group, said he shared with leadership Thursday his belief that if there’s going to be a manager’s amendment to the bill, it needs to be scored by CBO before a floor vote. “I’m not alone in that opinion,” he said.

A decision to proceed without a CBO score seems unlikely if GOP leaders want to stick to their timeline. The bill is expected to go to the Rules Committee, before the scheduled vote Thursday, although some members believe that timeline may slip given outstanding concerns.

“We will wait until next week to see,” GOP House Budget Chairman Diane Black of Tennessee said when asked if there was chance the bill might get delayed. “I believe that our conference made a promise to the American people and we need to follow through on our promise.”

Joe Williams contributed.

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