Republicans revamp Obamacare bill as Trump moves to promote overhaul

The president privately warned lawmakers of political fallout if Obamacare stays in place

Aaron P. Bernstein—Reuters
Speaker of the House Paul Ryan speaks at a news conference about Congressional efforts to repeal and replace Obamacare

WASHINGTON, D.C. — President Donald Trump warned Republican lawmakers Tuesday that voters will remember if they do not approve a plan dismantle Obamacare, as pressure grew on the businessman-turned-politician to win the first major legislative battle of his presidency.According to Republican Rep. Walter Jones of North Carolina,Trump told lawmakers in a closed-door meeting that if the Republican bill does not pass, they would face “political problems.” Jones said he thought Trump meant lawmakers could lose their seats.”The president was really clear: he laid it on the line for everybody,” House Speaker Paul Ryan, the leading proponent of the bill, told reporters. “We made a promise. Now is our time to keep that promise … If we don’t keep our promise, it will be very hard to manage this.”While Republicans control both chambers of Congress, the party’s leaders face a difficult task in uniting their members behind the healthcare bill, just the first of a series of reforms that Trump has promised including overhauls of the tax system and business regulations.Some conservative lawmakers believe the healthcare bill does not go far enough, while moderate Republicans worry it goes too far and that millions of Americans will be hurt by dismantling the 2010 Affordable Care Act, former President Barack Obama’s signature healthcare legislation.Party leaders hope to move the bill to the House floor for debate as early as Thursday. But the administration and House leadership can afford to lose only about 20 votes from Republican ranks or risk the bill failing, since Democrats are united against it.Repealing and replacing Obamacare was one of Trump’s main campaign promises and has been a goal of Republicans since it was enacted. This is the first major legislative push of Trump’s young presidency after taking office two months ago.Democrats oppose the Republicans’ plan, saying it would throw millions off health insurance and hurt the elderly, poor, and working families while giving tax cuts to the wealthy.Ron Wyden, the senior Democrat on the Senate finance committee, said he thought it would not take long for a political backlash to build, adding that he was at three town hall meetings recently in Oregon where opposition was obvious.”People between 50 and 65 are very much aware that they are about to get hit by a wrecking ball. Basically, in those areas, and you are talking about Trump voters, there are going to be real questions of people when they get immediate sticker shock (over) the cost of premiums,” Wyden said.Republican leaders recrafted the bill this week to try to satisfy critics, mainly fellow Republicans.Republican chairmen for two key committees said late Monday they proposed more funding for tax credits, which conservatives have opposed, that would give the Senate flexibility to help older people afford health insurance. Additionally, Obamacare’s taxes would be eliminated in 2017 instead of 2018.The amendments also addressed Medicaid, which is the country’s largest health insurance program and covers about 70 million people, mostly the poor. The changes would allow states to implement work requirements for certain adults, an idea championed by many conservatives, and to decide how they receive federal funds. Changes to the Republican health care proposal include:There are more tax deductions. The change would allow deductions for health expenses that amount to more than 5.8 percent of a patient’s income.Obamacare’s taxes would be eliminated in 2017. The old plan did not eliminate the taxes until 2018, drawing criticism that repeal measures didn’t happen fast enough.States would be allowed to implement work requirements for certain adults receiving Medicaid. Obamacare expanded Medicaid to 11 million able-bodied adults without children while conservatives have said that they want to be able require work of community service for the benefits.States could choose per capita allotments for Medicaid or block grants. Currently, Obamacare delivers Medicaid money on a per enrollee basis. State would be allowed to take a set amount of money for certain populations instead.States could not immediately expand Medicaid. The proposal still waits until 2019 to freeze Medicaid expansion, but it does stop any of the 19 states who haven’t yet from doing it now.Despite the changes, the Wall Street Journal reported the conservative House Freedom Caucus has enough votes to block the bill. Trump, who has not offered Obamacare repeal legislation of his own, did not talk “a whole lot about the healthcare bill except to vote for it,” Jones said of the president’s trip to Capitol Hill.The Club for Growth, an influential conservative lobby group, said it would spend at least $500,000 for ads on television and digital platforms urging members of Congress to defeat the bill.The Senate will also vote on the legislation and more changes could still be made.At a rally in Kentucky on Monday night, Trump said he also wanted to add a provision to the bill to lower prescription drug costs through a competitive bidding process.