The Republican push to repeal Obamacare — a move that could affect access to health care for hundreds of thousands of Georgians — appeared to be in jeopardy on Wednesday as the GOP struggled to win over holdouts within its own ranks.
But there were signs late Wednesday that the White House was willing to alter the measure to meet the concerns of conservatives, who were demanding repeal of Obamacare’s requirements that insurers pay for specified services such as maternity care and mental health counseling.
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Members of the House Freedom Caucus, the hard-line group spearheading the opposition, were expected at the White House early Thursday.
“Tonight is an encouraging night,” said Rep. Mark Meadows, R-N.C., leader of the caucus, who for days has said he has the votes to kill the measure. “But I don’t want to be so optimistic as to say the deal is done.”
After weeks of infighting, the full House is expected to vote Thursday on the GOP plan, known as the American Health Care Act. But on the eve of the vote, some moderates and hard-core conservatives remain steadfast in their opposition to the proposal, the latter demanding that Republicans live up to their promise to voters to gut Obamacare in its entirety.
Among its most ardent opponents: U.S. Rep. Jody Hice, a Georgia Republican and Freedom Caucus member, who on Wednesday afternoon told The Atlanta Journal-Constitution he can’t support a bill that “doesn’t go far enough.”
“I don’t know where this thing is going to go. They don’t have the votes right now. I can assure you of that,” Hice, of Monroe, said of House leaders on Wednesday afternoon. “Hopefully, we’ll be able to get this thing back to the drawing board and do what we promised the American people we would do.”
The Freedom Caucus on Wednesday suggested that the White House scrap the plan and start over. The group of conservative lawmakers also said it has 25 votes against the GOP proposal. House Speaker Paul Ryan can only afford to lose 22 Republicans and still pass the legislation in the face of united opposition from Democrats.
“I think they want to get this done tomorrow, and I agree with them: I want to get it done tomorrow too,” said U.S. Rep. Mark Meadows of North Carolina, who heads the Freedom Caucus. “But a self-imposed deadline doesn’t necessarily make for good policy.”
Still, party leaders and the Trump administration continued to apply pressure through a flurry of private meetings at the White House and on Capitol Hill in the hours leading up to Thursday’s vote. (Thursday also happens to be the seventh anniversary of the passage of President Barack Obama’s signature health law.)
Obamacare is collapsing, and doing nothing means good people get hurt, Ryan said in a Fox News’ interview Wednesday.
“We just believe we have a moral obligation and a duty now that we’re the governing party to step in front of that collapse — and, by the way, replace it with good reforms that work,” he said.
Big changes for Medicaid?
The GOP plan makes a host of changes to the Affordable Care Act, better known as Obamacare, that could fundamentally change access to health care for many Georgians — especially low-income residents in rural areas of the state.
Perhaps the biggest change: radically restructuring how Medicaid, the government health program for the poor, is funded.
Right now, the feds pay states a certain percentage of any Medicaid costs they incur. Georgia is among the states — those with large low-income populations — that benefit the most.
But the GOP plan would instead give states a flat rate for each Medicaid enrollee, which doesn’t account for changing demographics or states with aging populations with more expensive health care needs.
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Consumer advocates warn that would lead to cuts in services and in the numbers of people who qualify for the program as states try to make up for the loss in federal funding.
However, conservative Georgia lawmakers have long lauded the concept, known generally as “block grants.” They say Medicaid is a bloated program headed to insolvency, and block grants would give states more flexibility to improve efficiency and better meet the unique needs of the people they serve.
“If you (provide a) block grant to the states, you lose all the bureaucracy — the taking off the top of every ivory tower here,” said U.S. Rep. Barry Loudermilk, R-Georgia. “The state can serve more people with better service with less money. You could actually expand your coverage.”
Help for older Georgians?
The GOP plan would also make significant changes to tax credits that help people who don’t have health insurance through an employer buy their own.
Obamacare credits are based on family income, the cost of insurance and where you live. That setup benefits the poor the most. The GOP plan is mostly based on age, not income. It offers lump-sum credits between $2,000 to $4,000 depending on how old you are.
As a result, many older, poorer Georgians could lose out on thousands of dollars in tax credits, forcing some to drop coverage. Georgia State University estimates as many as 750,000 Georgians could lose coverage under the GOP plan in large part because of changes to tax credits and Medicaid.
Among a series of proposed changes to the Republican plan is an increase in financial help to Americans ages 50 to 64, who don't yet qualify for Medicare, the government health program for people 65 and older.
But it’s not yet clear how or to what extent that element would impact people’s ability to afford health coverage.
“The blueprint that the Republicans have put forward … is woefully inadequate as (an Affordable Care Act) replacement, and their modifications to it at this point are crumbs that don’t make it much better,” U.S. Rep. Hank Johnson, a Georgia Democrat, said Tuesday.
The fight ahead
Despite opposition, House leaders were resolved on Wednesday to push ahead.
The powerful House Rules Committee met to make final edits to the bill and set the rules of floor debate. Democrats criticized Republicans for moving ahead before the nonpartisan Congressional Budget Office released an updated estimate of the bill’s costs and health coverage levels.
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Meanwhile, Senate Majority Leader Mitch McConnell signaled he would like to make quick work of the bill next week.
The measure does not have enough Republican votes to pass in the Senate as written. It would likely need to be overhauled in order to advance there, which means that rapid action before the chamber’s two-week April recess will be very difficult.
Georgia’s two Republican U.S. senators, Johnny Isakson and David Perdue, have sounded positive notes about the House’s proposal and the necessity to quickly replace Obamacare. But both have been careful to make their critiques of the GOP legislation behind the scenes.
“This is less about doing this in the media than doing it in the meeting rooms up here where we should be doing it,” Perdue said Tuesday.
Spokeswoman Amanda Maddox said Isakson is still reviewing the House bill and would not comment on how he would vote. She said Isakson is supportive of a related Republican proposal that would means-test the bill’s tax credits.
» The Associated Press contributed to this article.
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