Congressional Republicans, on the precipice of repealing and replacing Obamacare, are facing a familiar and stubborn foe: themselves.
Infighting ensued immediately Tuesday as House and Senate Republicans dissected for the first time the American Health Care Act, the GOP vehicle for replacing former President Barack Obama’s signature law.
President Trump and Republican leaders made the case for the AHCA and warned conservative opponents not to stand in the way. Insurgent Republicans, deriding the bill as “Obamacare lite,” said they had the votes to block it and vowed to do so absent major changes.
The intraparty warfare was characteristic of congressional Republicans during the Obama years, and responsible for sinking some of the best deals the GOP could have hoped to achieve with so liberal a Democrat.
Now, once again, this time with a Republican in the White House, Republicans are threatening to stand in their own way and block themselves from an incremental policy victory and potentially major political win.
“We are divided. We have to admit, we are divided on replacement,” Sen. Rand Paul, R-Ky., who opposes the administration/GOP leadership bill, told reporters during an afternoon news conference. “We are united on repeal but we are divided on replacement.”
The Freedom Caucus, a group of Republican insurgents in the House, in concert with a few like-minded Republicans in the Senate, want Trump and House Speaker Paul Ryan, R-Wis., to de-link the repeal of the Affordable Care Act, from the replacement.
They are asking for passage of the former and then a robust debate on the latter.
Both the White House and Republican leaders made clear Tuesday that that proposal is dead on arrival. They are open to changes as the bill advances through the legislative process, which begins Wednesday, but the underlying legislation is non-negotiable.
Democrats are expected to provide few votes, if any, to help pass the AHCA. That means Republicans have little room for error, given they can only afford to lose 19 votes in the House and two in the Senate and still send the bill to Trump’s desk.
Senate Majority Whip John Cornyn, R-Texas, who like a majority of Republicans on Capitol Hill has not been critical of the AHCA, said the legislation is an improvement over the status quo, and he practically dared conservative critics to trip it up.
“I think every senator, every congressman, needs to ask themselves the question: did you run on repealing and replacing Obamacare, or not? And if you did, do you think it’s important to keep your promises?” Cornyn said. “I think it is. So, to me it’s not a whole lot more complicated than that.”
Republican factionalism from after the party won the House majority in 2010 through the end of Obama’s second term hamstrung GOP leaders’ ability to negotiate the best deal with the White House.
The circumstances have changed.
Trump is in office and vowed, on the campaign trail, to repeal and replace Obamacare, just as his allies in Congress have been doing nonstop for seven years. That means Republicans don’t have the same excuses for failure as in the past.
The question is whether Trump will be able to forge consensus, and whether Republicans will let him.
Administration officials have been in constant contact with Republicans in Congress who oppose the GOP healthcare bill, which Trump called “wonderful” in a tweet on Tuesday, asking what tweaks could be made to bring them on board.
Vice President Mike Pence was sent to Capitol Hill to meet with members of the House Freedom Caucus, during which he offered to negotiate but also warned them against obstructing.
Rep. Mark Meadows, R-N.C., the chairman of the groups, said afterward that he wasn’t swayed. “It doesn’t fundamentally lower healthcare costs,” he said. That’s my premise, and until I can see compelling healthcare costs and lower healthcare premiums for my constituents, we haven’t really accomplished anything.”
The key policy disagreements between the administration and moderates and some conservatives on the one side, and the other conservatives on the other, is how the bill addresses Medicaid and the use tax credits as a substitute for government subsidies to help people afford insurance.
Most Republicans want to make sure that people still have access to care they can afford after the GOP takes away the goodies that help them do that in Obamacare.
The critics, which include conservative advocacy groups, charge that that approach basically leaves Obamacare intact, but with Republican policy as window dressing. They want a more purely market-driven approach.
Sen. Thom Tillis, R-N.C., said Republicans had to be careful not to let the desire for perfection waste the opportunity they have to finally get rid of the Affordable Care Act.
“We need to go as far as we can to do what we said we would do if we got elected and were controlling Congress,” Tillis said.
