Paul Ryan Reveals Latest Changes To Republican Healthcare Bill

Tyler Durden's picture

As first discussed on Friday, in order to overcome vocal objections to Obamacare repeal by conservative republicans, the White House won the support of the Republican Study Committee members by agreeing to give states the option to impose work requirements on Medicaid recipients and the option to block grant Medicaid instead of the cap system in the bill.  Today, during the Sunday morning TV circuit, Paul Ryan elaborated further that House Republicans are working on additional changes to the Obamcare repeal bill which seek to provide more generous tax credits for older Americans, while confirming the addition of the work requirement for the Medicaid program for the poor.

Speaking on Fox News Sunday, Paul Ryan said Republican leaders still plan to bring the healthcare bill to a vote on the House of Representatives floor on Thursday, adding that leaders were working to address concerns that had been raised by rank-and-file Republicans to the legislation.  

"We think we should be offering even more assistance than the bill currently does," for lower-income people age 50 to 64, Ryan said of the tax credits for health insurance that are proposed in the legislation, one week after the CBO found it would cause higher premiums for people in their 50s and 60s. Ryan also said Republicans are working on changes that would allow federal block grants to states for Medicaid.

Coming into the weekend, Republicans remained deeply divided over the shape of Obamacare repeal, President Trump's first major legislative initiative which aims to fulfill his core campaign pledge to eliminate Obama's Affordable Care Act. As noted last week, Trump has been "wooing" lawmakers to vote for the bill, Reuters reported. He won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid.

Striking an optimistic tone, the Wisconsin Republican said "we feel very good where we are," adding "we're still having conversations with our members. We're making fine-tuning improvements to the bill to reflect people's concerns, to reflect people's improvements."

Ryan said he's also impressed with how President Trump is helping the GOP to "close this bill." "We feel like we're on track," Ryan said, "and we're right where we want to be."

However, holdouts remains.

Even as Ryan said he felt "very good" about the health bill's prospects in the House, a leading conservative lawmaker told the C-Span "Newsmakers" program that there were currently 40 Republican "no" votes in the House. While Republicans hold a majority in the chamber, they cannot afford to have more than 21 defections for the measure to pass. Representative Mark Meadows, the chairman of the hardline conservative House Freedom Caucus, said the bill would "absolutely not" pass the way it is now.

Meadows, a North Carolina Republican, also said the changes being considered for the Medicaid program would not go far enough, if they left it up to states to decide whether to put in place a work requirement.


An optional work requirement for Medicaid would be "a step backwards, not a step forwards," Meadows said in an appearance on C-Span's "Newsmakers."

Furthermore, even if the healthcare bill were to pass the House, it also would face significant challenges in the Senate. There, Senator Tom Cotton, a conservative Arkansas Republican who has been a critic of the legislation, said that the problem with the legislation was that it would not reduce premiums for people on the private insurance market. Lawmakers need to slow down and solve this problem, he said. "It's fixable, but it's going to take a lot of work," Cotton said on CNN's "State of the Union."

Elsewhere, Senator Rand Paul on Sunday said he does not believe proposed Republican healthcare legislation will pass through Congress. "I don't believe so. I think there's enough conservatives that do not want 'ObamaCare lite,' " Paul said on ABC's "This Week." Paul during the interview stressed a clean repeal of ObamaCare. “None of us ran on this plan. We ran on repealing ObamaCare because it doesn’t work,” Paul told ABC’s “This Week.”

Quoted by The Hill, Paul has dubbed the new GOP plan, released earlier this month by House Republicans, “ObamaCare lite,” and has vowed to vote against the measures once they reach the Senate.  “I was elected in 2010 right after it came into place, to repeal it,” Paul said of former President Barack Obama’s signature healthcare legislation.

In addition to conservatives, moderate Republicans have also expressed concerns about the bill, and their worries are often not the same as conservatives'. Speaking on NBC's "Meet the Press," Republican Senator Susan Collins of Maine said she was concerned about the impact of the proposal on older Americans. She also worried the bill would shift Medicaid costs to states -- something critics say a block-grant approach would only make worse.

Collins said coverage issues must also be dealt with, citing a report from the Congressional Budget Office that said 14 million people would lose health coverage under the House bill over the next year and 24 million over the next decade.

While there has been a modest uptick in optimism in recent days, should the upcoming House vote on Thursday fail to pass, Trump will face his first major rebuke by a republican-dominated Congress, which would be a major setback to Trump's entire domestic agenda, leading to a delay not only in Obamacare repeal, but also implementing tax reform, which as we discussed last week, Goldman now anticipates passing no sooner than Fiscal 2018.

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Goldennutz's picture




Manthong's picture

It would be interesting to see how little money it would take to undo his seat.

I think I have found the majority of it in-between the couch seats.

nmewn's picture

Lemme just check my Win Gauge over here...yep!...still red hot from all this wonderful winning! Lets drop the hammer down and see if we can blow this sucker up.

They said it was built to take it, lets find out ;-)

SWRichmond's picture

"The law known as the Affordable Care Act is repealed."

There.  Done.

Prisoners_dilemna's picture

"Words having universal scope, such as 'every contract in restraint of trade,' 'every person who shall monopolize,' etc., will be taken, as a matter of course, to mean only everyone subject to such legislation, not all that the legislator subsequently may be able to catch." American Banana Co. v. United Fruit Co., 213 U.S. 347 (1909)


26 USC § 5000A - Requirement to maintain minimum essential coverage

(a) Requirement to maintain minimum essential coverage

An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month.

(b) Shared responsibility payment

(1) In general

If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is liable under paragraph (3), fails to meet the requirement of subsection (a) for 1 or more months, then, except as provided in subsection (e), there is hereby imposed on the taxpayer a penalty with respect to such failures in the amount determined under subsection (c).


(d) Applicable individual

For purposes of this section— (1) In general The term “applicable individual” means, with respect to any month, an individual other than an individual described in paragraph (2) [Those enjoying state-approved religious exemptions], (3) [Individuals not a citizen or national of the United States or an alien lawfully present in the United States], or (4) [Incarcerated individuals].

(e) Exemptions

No penalty shall be imposed under subsection (a) with respect to


(2) Taxpayers with income below filing threshold

Any applicable individual for any month during a calendar year if the individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act is less than the amount of gross income specified in section 6012 (a)(1) with respect to the taxpayer.



26 US Code 7701

(14) Taxpayer

The term “taxpayer” means any person subject to any internal revenue tax.



42 USC § 18115 - Freedom not to participate in Federal health insurance programs

No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.



Title 26 of the US Code is The Internal Revenue Code which is where excise taxes are collected and codified.

Title 42 is The Public Health and Welfare


Perhaps these two sections of law were purposefully kept seperate so that you would "voluntarily comply".

Voluntary: Under no legal Obligation    Black's Legal Dictionary

hope_talk's picture
hope_talk (not verified) Prisoners_dilemna Mar 19, 2017 5:37 PM

I'm making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life. This is what I do...

abyssinian's picture

Paul Ryan is a clown, he's as bright as Nancy airhead Pelosi

aloha_snakbar's picture

The first change we need to make to OblowmeCare is to get Paul "Eddie Muenster" Ryan the fuck away from it...let him go back to servicing Bill Clintons wife...

sister tika's picture

Eddie Munster is a little, black-haired pig that squeals "Weeee-O!" every time Soros wants something.

flea's picture

It's easy: vacate the chair!

The Freedom Caucus should absolutely be doing this without fear or regret. Ryan has violated the trust he used to get the job.

Deperate times, desperate measures. And the measures aren't even that desperate.

TheLastTrump's picture

Repeal Obamacare completely 1/1/18.


That leaves 8 months to figure this shit out. You had 6 years but squandered it fools, now fucking well get busy.


No Obama Ryan Care = O.R.C.


ORC's, get it?

mary mary's picture

Since Ryan is Catholic, call it Catholicare.  Catholics like Ryan will get more government and insurance company jobs, and taxpayers will pay more.  It always works out that way.

44magnum's picture

Yep, Its the Catholics they control everything. Media, banking, etc. they hold dual citizenship one for USA and one Vatican. Always using the protestants, Muslims, to do there bidding behind the scene. 


DingleBarryObummer's picture

In Europe it's illegal to question the official holocaust story.  However, you can say and write whatever you want about the Jesuit power, Vatican, Catholic pedophilia issues, Assassins, Knights Templar etc. 

To learn who rules you, SImply find out who you are not allowed to criticize


mary mary's picture

I'll start blaming the Presbyterians when there are 4 Presbyterians on the USA Supreme Court.  Right now I see only Catholics and Jews, so I figure only Catholics and Jews have real political power in the USA.  Therefore, I blame them.  Of course, they both claim to have little interest in Big State, but that does not jive with the fact that they have locked everyone else completely out of the USA Supreme Court.

ThankUGartman's picture

By Catholic you mean Jesuit and Opus Dei is Ryan's branch. Does anyone go to the movies when we got these actors standing on the world stage? They'll have their Hollywood cohorts make movies with these plot lines soon enough if they haven't already in the previous 10 years. I like how they create a disaster then make a movie telling the bullshit version they want us to believe. I.e Hereafter -Japanese Tsunami 3/11/11. Knowing/Big Horizon-Gulf oil spill, Boston Marathon-Patriot day. Mark Wahlberg must really be on of their favorite actors. He even got a role as a engineer in Transformers3. Great casting there lol.

Elliott Eldrich's picture

U.S. Health care pre-Obama: Get sick, go to doctor, go to bankruptcy court.

U.S. Healh care under Obamacare: Get sick, go to doctor, go to bankruptcy court.

U.S. Health care under Trump / GOP: Get sick, go to doctor, go to bankruptcy court.

Same as it ever was...

mary mary's picture

LBJ, a Democrat, started this mess, in 1966, when he created Medicare and Medicaid.  That was the camel's nose under the tent.  40 years later, we are left with all camel, and no tent.  As intended.

Buckaroo Banzai's picture

"I'll have those niggers voting democrat for the next hundred years!" -- Lyndon Baines Johnson

Mikeyy's picture

"We have lost the South for a generation" said LBJ upon signing the Civil Rights Act.


What do you imagine he meant there buckaroo ?


Robert Trip's picture

Who died and made Ryan King?

And making people on Medicaid work for their coverage is brilliant.

However, let's make the inner city Blacks work for their Welfare first, before we put our walking wounded under the yoke of haviing to earn their medical treatment.

looseal's picture

No thanks!  My office got stuck taking in workfair employees in the old days when we still had paper folders.  Personnel had to ask them if they knew the alphabet.  Answer heard:  I know some of it.  Consequently, my file cabinet was a disaster.  

Oh, and only some of them bathe and wear clean clothes.  When they came to file I had to leave my office. The stench was awful.  

VWAndy's picture

 So now its the other teams turn to screw up the health care system even more. More left vs right kool aid. Same as the anti war stunt they pulled. War is bad, unless its my team doing the killing then its all good. Obama care was the greatest thing ever. If your a lefty. Now that the right is going to do the same thing. The righties will love it.

 Its not anyones fault but the kool aid drinkers on both sides. Simply because most folks never hold anyone on their team accountable.

  Just treat the industry like mom and pops are treated.

MuffDiver69's picture

The system is designed to make it hard to change. Hard to change even fuck ups...Trump made a good point the other day. If the republicans presented Obamacare the democrats would vote against it...Just the way it is...Politics

VWAndy's picture

 No they would vote to screw us all over. Thats one thing both parties always agree on. But they would make a good show of it.

  They made the system rather easy to change. As long as that change is for the worst. If its for the worst they dont even need to read it.

Lumberjack's picture

And exempt themselves once again...this time from everything...

"Gallup: U.S. Congress' approval rating highest since '09. Feb. 8 (UPI) -- The U.S. Congress' approval rating increased nine percent in one month to 28 percent, the highest since former President Barack Obama was inaugurated in 2009, a Gallup poll shows.Feb 8, 2017

Going back down to the single digits soon. Even the spammers here at ZH have slightly higher approval ratings.

VWAndy's picture

 Yeppers. It does my heart good to see so many good folks starting to catch on. Its not just on ZH either. Out in the real world people are starting to see right thru the lies. Not all that long ago I would have to spoon feed it to them slowly. The people that still make a living the old honest ways are not falling for these silly stunts like they used to.

slightlyskeptical's picture

Just like the Repubs voted against what was really Romney care.

MuffDiver69's picture

No matter what happens it goes to senate and they change it...then it goes back to house, which changes that...The only thing Ryan did was get it scored by CBO, which allows it to go forward...

We haven't had a budget in eight years. This is what legislating is and many of the American people ,media are clueless...Anyone remember Reagan and Tip O'Neil negotiating...If the republicans can't get something put together it's not Trumps fault they are clowns...Obamacare completely implodes and 2018 is all about getting 60 senators and they can write a new bill.....That's it...Its the way the system was designed ....Slow and hard to change...

artichoke's picture

We're not going to get 60.  It might be better to give up that idea, stop playing nice and realize that whatever we do we won't go below 50 in 2018.  So balls to the wall.  Just revoke the filibuster rule.  Hey, Reid started it, McConnell finishes it, Schumer we don't care what you think any more than Reid cared when McConnell protested and warned.

Pass the program, then reinstate the filibuster if things are looking iffy for 2020 where more R senators will be running for reelection.

At least under the Republicans, revenue bills start in the House as they must, unlike the Dems who at least twice (Patriot Act, Obamacare) started in the Senate with an old House bill that had not had a Senate vote, strip out 100% of the language, insert completely new language, pass it and send it back for "conference".

Robert Trip's picture

"If you can find your Doctor you can get your Doctor back."

brushhog's picture

I've just decided to try to stay as healthy as possible and when the time comes, I'll die. If I can afford some simple procedure or basic medicine out of pocket, fine. But if I need some type of major treatment for cancer or something similar, I'll just wrap my lips around a revolver. Chances are, they wont save me anyway and the quality of life as an invalid is not worth living.

flaminratzazz's picture

bankruptcy is easy and you can do it ever 6 years, dying, not so much.

brushhog's picture

Right then I can find a nice bridge to live under.

flaminratzazz's picture

keep making the house payment, they wont take it.. there are laws against kicking you out in the streets.

and a van down by the river is liberating.

brushhog's picture

Would live in a van, but yeah I have heard that they dont always take your house in the event of a bankruptcy.

flaminratzazz's picture

Credit cards are unsecured in no collateral..aka free money if you choose to say fvk em and tank your credit.

The Gauleiter's picture

Did that in '08.....9 years later they are foolish enough to trust me again

The Gauleiter's picture

There is a lot of room under the bridge between sanibel and captiva.....noseeums can be nasty though

pocomotion's picture

What if the revolver misfires? Or, you don't know it fired because it did it's job but you are in afterlife LIMBO? WOw what a bad choice when you could have had Trumpcare given to you by congressman and senators that have a better plan than the general populous.

brushhog's picture

You're right Id better use a shotgun

PoasterToaster's picture
PoasterToaster (not verified) brushhog Mar 19, 2017 2:05 PM

Just as planned.  Doesn't it piss you off that the control freaks in charge have gamed out the depopulation so well?  And using currency to do it is a stroke of genius, because most people have been indoctrinated  that they've done something wrong if they can't afford something.

artichoke's picture

The real issue of depopulation and repopulation has to do with our insufficient production of children.  A few good fucks in your 20's are far more important than the decade between 80 and 90.  I say this as a 60 year old who reproduced, but I wish I had started sooner and society hadn't been so cleverly set up in multiple ways to discourage it.

The Gun Is Good's picture

"But if I need some type of major treatment for cancer or something similar, I'll just wrap my lips around a revolver."

Wait. Be sure to knock off a few of the elite on your way out. Why not? You'll be doing the rest of us a favor and making the world a considerably better place.

Stochdoc's picture

What the hell defines lower income for those 50 - 64?


If its income after premiums, that's pretty much all of us.

Stochdoc's picture

What the hell defines lower income for those 50 - 64?


If its income after premiums, that's pretty much all of us.

flea's picture

I'm beginning to see 'moral hazard' all over health care. Prices are only responding to the avalanche of free money coming at them. Just close the whole thing down, including Medicaid (leave Medicare for another day). Let the states decide the level of their safety nets: there's more acccountability and no printing presses.

slightlyskeptical's picture

The cost side of medical care needs to be fixed before any type of insurance plan will be workable.

We also need to redine how we view healthcare insurance as a year to year proposition since diseases and ilnesses don't have a timetable for when they occur and end.

We also need to accept the fact that people need to be covered for life. Those who decline insurance when they are healthy and young, only to purchase it when they are older and sick, are driving up the costs for everyone. There needs to be an new ideaology that you purchase health insurance when you are young to make care possible when you are old. We need to get rid of the old ideology that the young need to pay for the current old and sick. It is only this way because our healthcare system has been designed under the wrong ideologies.