Republican leaders late Thursday conceded major changes to their Obamacare replacement plan in a last-minute effort to win over holdouts within the GOP who had opposed the bill.
The biggest change to the plan: eliminating “essential health benefits” such as maternity care and mental health services, which Obamacare requires insurers to offer. Members of the hard-line conservative Freedom Caucus argued the benefits make insurance costs too high and refused to vote for the GOP plan if they remained.
House Speaker Paul Ryan, R-Wis., and a handful of top White House aides, including budget director Mick Mulvaney and senior adviser Kellyanne Conway, rallied Republicans behind closed doors in the Capitol.
Mulvaney’s message, according to a GOP aide, was that this was President Donald Trump’s final offer on health care and that GOP lawmakers could take it or leave it. House Republicans who previously served in the armed forces also spoke in favor of the plan in the closed-door meeting, comparing it to their own experiences on the battlefield.
“That was probably the most emotionally moving hour and a half I’ve spent in a long time,” said U.S. Rep. Barry Loudermilk, R-Ga. “The unity was incredible.”
As the hour grew late, the U.S. House gathered for a procedural vote that paved the way for a final vote on the legislation as soon as Friday afternoon.
What was unclear late Thursday was whether the eleventh-hour change was enough for the legislation to pass.
Thursday’s late-night developments marked a significant turnaround from earlier in the day when the Republican health plan appeared to be in peril.
The U.S. House was originally set to vote on Thursday — a deadline self-imposed by Republicans that coincided with the seventh anniversary of former President Barack Obama’s signature health law. But it was postponed when it became clear GOP leaders didn’t have the votes needed for passage.
Still, supporters of the bill remained optimistic.
“I am confident we’re going to get it done,” U.S. Rep. Buddy Carter, R-Ga., said Thursday evening to The Atlanta Journal-Constitution. “I’ve not been one to want to rush things at all, or to necessarily adhere to a timetable. If we could get it done tomorrow, that’s fine. If it takes us through the weekend, that’s fine.”
Freedom Caucus members, including U.S. Rep. Jody Hice, R-Ga., said ahead of Thursday night’s meeting that the Republican bill didn’t go far enough and any plan should gut Obamacare entirely. Hice later appeared more optimistic about the new changes but said he was still undecided.
“I’m encouraged with the president’s willingness to reach out and work with us, and we’ll be meeting here in a little bit to discuss it a little further,” Hice said of the Freedom Caucus.
The group’s recalcitrance frustrated some of the bill’s biggest backers from Georgia.
“This is about a couple of self-serving people like (Freedom Caucus chairman) Mark Meadows, who are pulling a cheap political stunt for their own glorification at the expense of the country,” said Tifton Republican Austin Scott.
Moderate Republicans raised separate concerns about the GOP plan, saying it could leave too many people uninsured.
Democrats, meanwhile, continued to hammer their colleagues across the aisle for rushing to pass a complicated bill that threatens to strip millions of Americans of insurance.
“The real reason for today’s repeal vote postponement is that Republicans want to avoid committing political suicide by voting to throw 24 million people off of their health care, while leaving millions more with higher costs for less coverage,” said U.S. Rep. Hank Johnson, D-Ga.
High stakes for Georgia
An estimated 750,000 Georgians — including older, working-class people in rural areas — could lose their health insurance under the GOP plan, a recent analysis by Georgia State University shows.
That would result in part from the plan lowering the amount of tax credits Georgians receive to help buy health insurance — by thousands of dollars in some cases.
Also on the line: the possible loss of billions of dollars in federal funding to the state’s Medicaid health program for poor Georgians.
The plan would drastically change how the federal government pays states to help run their Medicaid programs. Nationwide, it could reduce federal Medicaid funding by $880 billion over a decade, according to the nonpartisan Congressional Budget Office.
Critics of the bill expressed encouragement that Congress appeared to be slowing its breakneck effort to pass the GOP plan.
“Congress should not rush through passing a bill that would hurt Georgia’s state budget and leave fewer Georgians with comprehensive health coverage,” said Laura Harker, a health policy analyst with the left-leaning Georgia Budget & Policy Institute.
Hospitals across Georgia could also be hit hard by the Republican plan.
Georgia hospitals already provide an estimated $1.75 billion a year in free care to the uninsured. A large influx of newly uninsured patients would be particularly difficult for smaller hospitals in rural areas that are already in dire financial straits, leading some to close their doors for good.
The Georgia Hospital Association stands opposed to the GOP bill.
“Our health care system is at a crossroads,” association president Earl Rogers wrote in a letter to Georgia lawmakers in Washington. “Too many residents have little or no access to health care, and the institutions created to care for them, our local hospitals, are struggling to remain financially viable.”
What’s the cost?
GOP leaders maintain the plan would ultimately lower premiums and provide more health coverage options. Earlier this week, they proposed a series of changes to the legislation to appeal to hard-line conservatives.
A new analysis of those changes released Thursday afternoon by the Congressional Budget Office, or CBO, threatened to throw negotiations into further disarray. Congress’ nonpartisan scorekeeper estimated the changes that leaders were pushing would lower an initial estimated $340 billion reduction in the federal deficit by 44 percent to $150 billion.
On top of that, leaders’ tweaks would not change original estimates of how many people would become uninsured or how premiums might be affected.
The CBO continues to predict 24 million people will lose their insurance over the next decade under the bill.
As for premiums, adopting recent versions of the Republican bill would increase average premiums by the same amount as the original proposal: by about 15 percent to 20 percent for single policy holders before 2020. Premiums are projected to decrease by about 10 percent in later years, also unchanged.
The road ahead
Meadows, the North Carolina Republican who leads the Freedom Caucus, said Thursday that Republicans would “get to the finish line” on the GOP’s Obamacare replacement bill.
Democrats and consumer advocates warn doing away with the essential health benefits, as well as major changes to tax credits and Medicaid funding, would hurt millions of Americans.
Even if the bill passes the House, it faces an even bigger battle in the Senate, where it doesn’t appear to have the votes to pass as currently written.
Still, the Trump administration expressed optimism that Republicans would come together.
“We continue to see the number go up, not down, and that’s a positive sign,” Trump spokesman Sean Spicer said during a press briefing Thursday. “… I anticipate that we will get there.”