WASHINGTON — Congressional Republicans' newly released bill to repeal and replace Obamacare is drawing mixed reviews from the GOP and strong opposition from Democrats, underscoring just how difficult it will be to pass the legislation.
In the Republican-led House, some conservative GOP members have already come out against the bill, while others support it — or at least are open to further discussion.
“In simple terms, I don’t think we promised the voters we’d repeal it, but we’re gonna keep taxes in place. We’re gonna repeal it, but we’re gonna keep Medicaid expansion in place for four years and we’re gonna repeal it, but start a new entitlement with a fancy name of ‘advanceable refundable tax credits,' " Ohio Rep. Jim Jordan told USA TODAY. "I don't believe this is actually going to bring down the cost of treatment, I don't know that this is going to bring back affordable insurance," he continued.
Jordan is the former chairman of the House Freedom Caucus, a group of roughly 40 hardline conservatives. If the caucus withholds their votes en masse, they can halt the legislation from moving forward. No Democrats are expected to vote for the repeal, and House Republicans can only lose about 20 votes before they lose their majority.
The Freedom Caucus had previously decided they wouldn't vote for anything less than the full repeal that was passed in 2015 by both the House and Senate. The legislation was largely symbolic as President Obama had always maintained he would veto any attempts to repeal the health care law. And he did when the bill finally made it to his desk.
"We're making it way too complicated. Why don't we just vote on and pass what we all voted on and passed just a few months back, it makes it so simple. Everyone agrees with that," Jordan said referring to the 2015 repeal. "And then have a separate bill, we can have that debate on 'replace' but you get the 'repeal' done like we told the voters we were gonna do."
"Obamacare 2.0," Rep. Justin Amash, R-Mich., another Freedom Caucus member, tweeted Monday with a link to the bill.
Freedom Caucus Chairman Mark Meadows, R-N.C., who had said last week he wouldn't vote for a leaked draft of an Affordable Care Act replacement bill over a series of provisions, still saw issues with the new draft but seemed more optimistic.
"I can say that there needs to be continued negotiations in order to get to a consensus of support," Meadows told USA TODAY. But he added there were changes from the previous draft that he called "positive moves in the right direction.”
North Carolina Rep. Mark Walker, chairman of the Republican Study Committee, a group of roughly 170 conservatives, had also said he wouldn't vote for the prior draft but saw some opportunity in the new legislation.
"I applaud the movement and believe it is the right direction. We are carefully reviewing this legislation looking in three main areas of shared conservative concern: protection of the unborn, elimination of Obamacare’s Medicaid expansion and ensuring the tax credits are fiscally responsible," he said.
But Sen. Rand Paul, R-Ky., has already made up his mind. "The House bill that's been put forward is 'Obamacare lite.' It won't work, premiums and prices will continue to spiral out of control," Paul said on Fox & Friends Tuesday morning.
But Paul expressed confidence that the draft released Monday wasn't the final piece of legislation. His statement was echoed by a tweet from President Trump on Tuesday saying the legislation was "out for review and negotiation."
"I spoke with the president yesterday and I think he's open-minded on this. He wants Obamacare repeal like all conservatives do, but he realizes that conservatives have a lot of objections," Paul said. "Obamacare lite doesn't fix it and I think it's a real mistake to go for this. But the negotiation will be conservatives saying 'hey, we're not going to take Obamacare lite.' "
Michael A. Needham, CEO of Heritage Action, the advocacy arm of the conservative think tank the Heritage Foundation, issued a blistering review of the draft Tuesday morning: "In many ways, the House Republican proposal released last night not only accepts the flawed progressive premises of Obamacare but expands upon them."
Needham echoed conservative calls for a full repeal and then conversation about how to move forward on a replacement. The Heritage Foundation has been one of the most influential groups helping conservative lawmakers set their agenda in Congress.
In the Senate, where Republicans hold a slim majority of 52 seats, GOP leaders are also in danger of losing the support of moderate Republican senators from states that expanded their Medicaid programs for low-income residents with help from the federal government as part of Obamacare. Under the proposed American Health Care Act, people who live in the states that expanded Medicaid would be able to enroll in the program for just three more years, until Jan. 1, 2020.
Just ahead of the public release of the bill, four GOP senators sent a letter to Senate Majority Leader Mitch McConnell, R-Ky., raising concerns based of a previous draft that the a repeal would harm “the core of the health care safety net for individuals across the country” by scaling back the Medicaid expansion which was put in place under Obamacare.
“The Affordable Care Act is not working for states or the federal government and must be repealed and replaced with a plan that reforms Medicaid and protects individuals and their families over the long term,” Sens. Rob Portman, R-Ohio, Shelley Moore Capito, R-W.Va., Cory Gardner, R-Colo., and Lisa Murkowski, R-Alaska, said in the letter. “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states."
After the official legislation was out Monday night, Portman spokesman Kevin Smith said, "We'll review the text and consult with expansion state governors and policy experts in Ohio before making any decisions."
Missouri Sen. Roy Blunt was not confident about the bill's ability to pass in it's current form Tuesday. He told local radio station KMBZ that "it may not be a plan that gets a majority votes and let's us move on."
"I think the nucleus of the plan is clearly there and the President says it's negotiable and so do House members," he continued in an interview that was first reported by CNN. "So, I'll be interested to be a part of that negotiation as we work toward a majority in the House and Senate that puts a bill on the President's desk."
House Ways and Means Chairman Kevin Brady, R-Texas, who helped craft the legislation, said, "House Republicans are answering President Trump’s call to action with legislation to repeal this failing law."
"Seven years ago, Obamacare put Washington in control of Americans’ health care," Brady said in a statement. "And for seven years, Washington has been failing to deliver results. Families can’t afford their premiums, patients can’t visit the doctor they like, and fewer insurers are offering coverage options every day. With President Trump, House Republicans are taking a stand. Our legislation transfers power from Washington back to the American people."
House Speaker Paul Ryan, R-Wis., predicted that a "unified Republican government" would pass the replacement bill.
“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare," Ryan said. "This will proceed through a transparent process of regular order in full view of the public."
House Majority Leader Kevin McCarthy, R-Calif., said that Republicans are going to fix the problems that Democrats created with Obamacare.
“Republicans didn’t create Obamacare or all the problems that followed — from rising premiums to crumbling exchanges to bankrupt co-ops to lost plans and restricted networks," McCarthy said. "We didn’t create these problems, but we’re going to fix it."
Democrats said the GOP bill would force many Americans to pay more for health care. Senate Republicans can repeal Obamacare with just 51 votes, but they need help from Democrats to reach the 60-vote supermajority that may be required to replace parts of the law.
"Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care," said Senate Minority Leader Chuck Schumer, D-N.Y. "This plan would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care — all so insurance companies can pad their bottom line."
Sen. Ron Wyden, D-Ore., said the bill "decimates Americans' health care."
House Minority Whip Steny Hoyer, D-Md., said Republicans don't have a workable health care plan.
"This repeal charade must end," Hoyer said. "Republicans have had seven years to show they have a better way to cover millions of Americans, protect consumers, and bring costs down. ... Now in full control of the government, Republicans will be held accountable for whatever happens to our health care system under their watch."