Paul Ryan Reveals Latest Changes To Republican Healthcare Bill

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.