House Freedom Caucus Heads to the White House Ahead of Obamacare Repeal Vote

The House is scheduled to vote on the Obamacare repeal health care bill some time today, but GOP leaders are still struggling to get conservatives and centrist Republicans on board.

House Speaker Paul Ryan and President Donald Trump are working both sides of the Republican conference in an attempt to get them closer to supporting the bill.

Trump and White House officials have been courting the conservative House Freedom Caucus, while Ryan met with centrists in a closed-door meeting Wednesday night.

Conservative lawmakers say they want to repeal Obamacare’s insurance regulations, which are currently left in place under the GOP’s health care plan, called the American Health Care Act.

Ryan initially said the regulations couldn’t be rolled back in the bill because of Senate rules. But last night, leaders seemed open to making changes to the bill giving conservatives what they wanted.

Their softening, though, came as centrist Republicans slowly started announcing their own opposition ahead of today’s likely vote.

Reps. Charlie Dent, R-Pa., and Jaime Herrera Beutler, R-Wash., were the latest to do so.

“In the final analysis, this bill falls short,” Herrera Beutler said in a statement this morning. “We can’t give up on repealing Obamacare with a solution that provides affordable, high-quality health care to all Americans. I will remain active and engaged at every step until Congress gets this right.”

House Republicans were supposed to meet first thing Thursday morning, but canceled their meeting.

Instead, all eyes appear to be on the White House, where Trump will meet with Freedom Caucus members at 11:30 a.m. this morning to further negotiate the details of the bill.

Before the meeting, the president spoke to individual Freedom Caucus members by phone.

Conservative lawmakers were attempting to convince Trump to repeal Obamacare’s regulations, including its essential health benefits requirements, a list of 10 services insurance plans were required to cover without copayments.

Trump and White House budget director Mick Mulvaney said Wednesday they were working with the House and Senate to eliminate the regulations.

But so far, no legislative changes to the bill have been released.

Instead, the House Rules Committee, which met late into the night Wednesday, approved a “same-day rule” along party lines that allows the House to vote for the rule and the bill the same day it is before the committee. The rule sets the parameters for debating legislation and which amendments can be considered.

Typically, the House is required to wait at least one day before it can consider a rule approved by the committee.

But by passing a same-day rule, the House can consider a rule and the underlying bill the same day it’s before the Rules Committee.

Lawmakers debated whether to pass the same-day rule on the House floor this morning, but went into recess.

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What the CBO Score Really Means for the GOP Health Care Bill

Last week, the Congressional Budget Office released a score of the Republican leadership’s answer to Obamacare, the American Health Care Act.

This budgetary analysis projects that the GOP bill would reduce the number of insured by 24 million, but would also decrease the deficit by $337 billion. It also reported the bill would reduce federal outlays by $1.2 trillion and lower federal revenue by $0.9 trillion by getting rid of taxes, fees, and fines.

As with any evaluation of large-scale legislative changes, there is great uncertainty surrounding this CBO score.

This uncertainty is exerting a direct influence on the GOP debate and on what amendments will ultimately end up in the final bill. Let’s take a closer look at some key takeaways from the CBO score as well as where it falls short.

According to the CBO score, the largest projected savings in the GOP bill come from reforms to Medicaid, along with the elimination of Obamacare’s subsidies in the individual market.

But the CBO’s score on Medicaid may be overstated.

The score reflects an assumption that more states would likely have expanded Medicaid in the future under Obamacare, when in fact this may not be true. Thus, CBO’s projection that 14 million fewer people would be insured due to not having Medicaid under the GOP plan might be too high.

This uncertainty also has secondary effects.

In Medicaid, the CBO projects that these changes will result in $880 billion in savings from 2017 to 2026. While a portion of these savings come from reforming the Medicaid program with per capita caps, a large portion comes from fewer people being on the program.

Many analysts and legislators have questioned the magnitude of the insurance losses due to the American Health Care Act, but there are tradeoffs that should be acknowledged. If coverage losses are less, so are budget savings.

The CBO estimates that tax credits in the House legislation will lead to less coverage than Obamacare due to the credit being less generous on average, especially for older Americans as well as some lower-income Americans. It estimates that coverage losses will be around 2 million in 2026 in the non-group market.

This number would be against a baseline that assumes Obamacare will enroll 7 to 8 million more people in the individual market, when in reality it does not appear this will be the case.

Much of the uncertainty also stems from the CBO’s past difficulties in accurately evaluating the effects of mandates and subsidies within the individual market.

On a March 15 Facebook event, Doug Elmendorf, former CBO director and Harvard Kennedy School dean, discussed some of the issues the CBO encountered when he oversaw the scoring of Obamacare.

He said:

We overestimated the number of people in the insurance exchanges by a lot—about 2-to-1. And we underestimated the number of people [to be added] on Medicaid significantly.

He went on to highlight that eligibility is difficult to determine for lower incomes, which is one of the reasons one would observe these sorts of discrepancies.

For example, in 2010, the CBO said that there would be 21 million people enrolled in the exchanges by 2016. The reality is that this number was much closer to 10 million.

While a troubled implementation played a role in lowering the number of people that signed up, the CBO might also ascribe too much power to the individual mandate.

In fact, Elmendorf thinks this is the case. He admits, “One thing we misjudged at the CBO was how effective the mandate, penalties, and subsidies would be at moving people into the exchanges.”

In the score of the American Health Care Act, the CBO predicts that 14 million will lose coverage next year, due largely to the repeal of the individual mandate. This suggests the CBO might still need to revisit its assumptions about the power of mandates.

Of the aggressive assumptions made in this score, this might be the most powerful, considering 36 percent of that reduction is in Medicaid—something the law does not strongly touch until 2020.

Additionally, assuming such a strong effect of the mandate in the Medicaid program leads one to question the assumptions the CBO has made about Medicaid enrollees.

Moving forward, various amendments will force adjustments to scores and speculation around the effects of the American Health Care Act.

An example of something important that we’ve already seen show up in the House Rules Committee’s amendments is a change to the rates at which the per capita cap in Medicaid grows. The amendments would increase the growth rate for elderly and disabled populations from medical inflation to medical inflation plus one.

Such changes will cut into budget savings estimates from the CBO, while other amendments such as Medicaid expansion freezes could push a score in the opposite direction.

In other words, on top of the uncertainty surrounding scores, it is important to acknowledge that future amendments can have drastic effects on the bottom line.

While the CBO’s score of the American Health Care Act might overstate the coverage effects of the law, it does provide important insight into the diverse effects and tradeoffs within the law. Moving forward, the CBO will continue to evaluate the GOP bill and forthcoming changes.

For Congress, it is important to acknowledge the limitations and uncertainty of such a large-scale score, but also very crucial to utilize these evaluations to have transparent discussion about the real effects of this legislation.

The post What the CBO Score Really Means for the GOP Health Care Bill appeared first on The Daily Signal.

Conservative House Freedom Caucus Could Block Obamacare Plan From Passing

With 25 of its members prepared to oppose the House GOP’s plan to repeal and replace Obamacare on Thursday, the House Freedom Caucus says it has the votes needed to block the bill from advancing out of the House.

Efforts to sway Republicans to switch their votes in favor of the bill are coming down to the wire, as the House is expected to vote on the health care plan Thursday. But even as the White House continues its charm offensive, it doesn’t appear the number of lawmakers opposed to the bill is moving at all, which puts its future in jeopardy.

According to Alyssa Farah, spokeswoman for the House Freedom Caucus, 25 of the group’s members will vote against the bill, and the conservative caucus encouraged GOP leaders to “start over.”

Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, reaffirmed his intent to vote against the bill on Twitter.

In addition to members of the Freedom Caucus, a number of centrist Republicans have come out against the bill as well. Republican Reps. Leonard Lance of New Jersey and Ileana Ros-Lehtinen of Florida both say they plan to oppose the bill.

They were joined by Rep. Frank LoBiondo, R-N.J., who announced his opposition to the bill Wednesday.

“Simply put, this bill does not meet the standards of what was promised,” he said in a statement. “It is not as good as or better than what we currently have.”

While the Freedom Caucus puts the number of “no” votes at 25, Rep. Thomas Massie, R-Ky., said he has spoken with 29 conservatives who, like him, opposed the bill as of Tuesday evening.

“What are the people saying that are for this on Capitol Hill? Well, they’re trying to tell us it’s a binary decision, that you can either take it or leave it,” he said in an interview with Breitbart Radio. “We think the negotiation starts when one party says no. That’s why we’re going to say no.”

Massie also took to his Twitter account to reiterate his position on the House GOP’s health care bill.

With 237 seats in the House and five vacancies, 22 Republican votes against the legislation would block the plan from advancing to the Senate.

So far, just one Republican who opposed the legislation has switched his vote.

Rep. Lou Barletta, R-Pa., said Tuesday he couldn’t support the GOP’s health care plan because it didn’t include provisions to verify that illegal immigrants wouldn’t get access to the tax credits.

But Barletta announced Wednesday he would be voting “yes” on the legislation, called the American Health Care Act, after meeting with House Speaker Paul Ryan and President Donald Trump on Tuesday night.

“The president gave his full support to legislation I will introduce to deny health care tax credits to illegal immigrants, and the speaker promised to bring the bill to the House floor for a vote,” Barletta said in a statement Wednesday. “Because my concerns were met, I will vote for the bill with the understanding that my bill will receive full consideration on the House floor next month.”

Despite the strong opposition from the Freedom Caucus, the White House seemed confident the bill would pass the lower chamber.

“This count keeps getting stronger for us,” White House press secretary Sean Spicer told reporters today.

Ryan, too, seemed confident the health care proposal would pass and Thursday’s scheduled vote would continue as planned.

“We feel pretty good,” he told Fox News on Wednesday. “We know we feel good at the end of the day here because members promised we would repeal and replace this disastrous and collapsing law.”

“We’re talking to our members,” the Wisconsin Republican continued. “We’re not losing votes.”

The House Rules Committee took up the bill Wednesday morning and, at the time of publication, continued to debate the legislation.

Conservatives continue to take issue with the legislation because of the impact it will have on the cost of premiums.

An analysis of the bill from the Congressional Budget Office found that the bill would cause premiums to rise 15 to 20 percent in 2018 and 2019.

The lawmakers believe Obamacare’s essential health benefits requirements, a list of services insurance plans are required to cover without copayments, need to be repealed for premiums to come down in price.

Conservatives appear to have an ally in Trump, who said he would call on the Senate to include a repeal of the essential health benefits requirements when it takes up the House bill, according to reports.

While the conservatives are pushing Republicans to include a repeal of the essential health benefits requirements and other insurance regulations in their health care bill, leaders have dug in their heels and warn that an inclusion of those provisions wouldn’t pass muster in the Senate.

GOP leaders attempted to gin up support for the bill from conservative and centrist Republicans on Monday when they released changes to the health care plan.

The proposal repealed Obamacare’s taxes in 2017 instead of 2018, and made further modifications to the Medicaid expansion, including a freeze of the expansion in 2020. The plan also changed the tax credits for low-income Americans.

But the changes weren’t enough to sway the lawmakers, who still are pushing for further negotiations.

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What Constituents Are Telling Conservative Lawmakers About GOP Health Care Bill

Constituents of several conservative lawmakers are speaking up because they view the Republican health care replacement as too similar to the Affordable Care Act.

“A large majority of constituents contacting Congressman [Jim] Jordan about [the American Health Care Act] are opposed to it,” said Darin Miller, a spokesman for Jordan, R-Ohio. Jordan was formerly chairman of the House Freedom Caucus, a group of conservative lawmakers.

“They want him to fulfill the promise of repealing Obamacare and replacing it with legislation that reduces premiums and is patient- and doctor-centered, not Washington-centered,” added Miller.

Alexei Woltornist, the communications director for Rep. Warren Davidson, R-Ohio, told The Daily Signal that the congressman has received almost no phone calls from constituents in favor of American Health Care Act.

“Last I checked the count, we received almost 300 calls opposed and only one in favor,” said Woltornist.

After White House press secretary Sean Spicer claimed Republican legislators would “pay a price at home” if they did not vote for the American Health Care Act, Alyssa Farah, the communications director for current House Freedom Caucus chair Rep. Mark Meadows tweeted that the North Carolina GOP congressman’s phone had been “ringing off the hook” with constituents calling to thank him for his opposition against the Republican health care bill.

The vast majority of comments from Meadows’ supporters on his Facebook page also voice opposition to the GOP’s health care bill.

One commenter, Cheryl from Asheville, N.C., responded to Meadows’ post about his opposition to American Health Care Act by saying, “thank you for voting NO. Please continue to look at all of the aspects of the ACHA, and please pay special attention to how this impacts our most vulnerable populations- the elderly and those chronic disabilities and conditions that prevent them from working.”

Tina, another commenter on Meadows’ Facebook post, said “your dedication to keeping your promise of full repeal to ease the burdens from Obamacare for the American public is the best. Just because Speaker [Paul] Ryan and President [Donald] Trump say their bill is a repeal and will bring down costs, does not make it so. Your conviction to stand against party leadership is commendable.”

Rep. Thomas Massie, R-Ky. said that he received 275 phone calls from constituents advocating for opposition of what he calls “Obamacare Lite,” and only four calls in support of the American Health Care Act.

Adam Brandon, president of limited government advocacy group FreedomWorks, spoke highly of conservatives opposing the Obamacare replacement bill and highlighted their grassroots support, “The House Freedom Caucus knows they have the support of the major conservative groups: FreedomWorks, Club for Growth, Americans for Prosperity, Heritage Action, and Tea Party Patriots — along with our activists,” Brandon said.

“We brought a thousand people from around the country in person to support members of the House Freedom Caucus and other members working hard to keep their campaign promises,” he added.

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What Constituents Are Telling Conservative Lawmakers About GOP Health Care Bill

Constituents of several conservative lawmakers are speaking up because they view the Republican health care replacement as too similar to the Affordable Care Act.

“A large majority of constituents contacting Congressman [Jim] Jordan about [the American Health Care Act] are opposed to it,” said Darin Miller, a spokesman for Jordan, R-Ohio. Jordan was formerly chairman of the House Freedom Caucus, a group of conservative lawmakers.

“They want him to fulfill the promise of repealing Obamacare and replacing it with legislation that reduces premiums and is patient- and doctor-centered, not Washington-centered,” added Miller.

Alexei Woltornist, the communications director for Rep. Warren Davidson, R-Ohio, told The Daily Signal that the congressman has received almost no phone calls from constituents in favor of American Health Care Act.

“Last I checked the count, we received almost 300 calls opposed and only one in favor,” said Woltornist.

After White House press secretary Sean Spicer claimed Republican legislators would “pay a price at home” if they did not vote for the American Health Care Act, Alyssa Farah, the communications director for current House Freedom Caucus chair Rep. Mark Meadows tweeted that the North Carolina GOP congressman’s phone had been “ringing off the hook” with constituents calling to thank him for his opposition against the Republican health care bill.

The vast majority of comments from Meadows’ supporters on his Facebook page also voice opposition to the GOP’s health care bill.

One commenter, Cheryl from Asheville, N.C., responded to Meadows’ post about his opposition to American Health Care Act by saying, “thank you for voting NO. Please continue to look at all of the aspects of the ACHA, and please pay special attention to how this impacts our most vulnerable populations- the elderly and those chronic disabilities and conditions that prevent them from working.”

Tina, another commenter on Meadows’ Facebook post, said “your dedication to keeping your promise of full repeal to ease the burdens from Obamacare for the American public is the best. Just because Speaker [Paul] Ryan and President [Donald] Trump say their bill is a repeal and will bring down costs, does not make it so. Your conviction to stand against party leadership is commendable.”

Rep. Thomas Massie, R-Ky. said that he received 275 phone calls from constituents advocating for opposition of what he calls “Obamacare Lite,” and only four calls in support of the American Health Care Act.

Adam Brandon, president of limited government advocacy group FreedomWorks, spoke highly of conservatives opposing the Obamacare replacement bill and highlighted their grassroots support, “The House Freedom Caucus knows they have the support of the major conservative groups: FreedomWorks, Club for Growth, Americans for Prosperity, Heritage Action, and Tea Party Patriots — along with our activists,” Brandon said.

“We brought a thousand people from around the country in person to support members of the House Freedom Caucus and other members working hard to keep their campaign promises,” he added.

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As Republicans Debate Health Bill, Let’s Remember Why Americans Want Obamacare Repeal

With Congress enmeshed in determining the “what” of Obamacare repeal—that is, what gets included in the Republican bill—pausing to revisit the “why” of Obamacare repeal offers important guidance for the path forward.

While Obamacare has been politically polarizing from the beginning, the broader public opposition to the law is not driven mainly by partisan animus.

If that were the case, opposition would have diminished at least somewhat over the last six years. Certainly that is what Obamacare’s supporters expected would occur.

Yet clearly that is not what has happened.

Rather, the “why” of repeal primarily stems from public opposition to the law’s basic construct, reinforced by people’s negative experiences with the law’s consequences.

Obamacare’s basic construct is to take control of private health plans and convert them into off-budget extensions of federal programs.

As one of the law’s supporters explained back in 2010, its design “transforms health insurance into a public accommodation,” and turns private health insurance into “a regulated industry … that, in its restructured form, will therefore take on certain characteristics of a public utility.”

The architects of Obamacare implemented that construct by imposing on private health plans new coverage requirements such as “essential benefits,” “preventive services,” and limits on plan cost-sharing.

They also enforced cross subsidies—such as limits on age rating, minimum actuarial value standards, and minimum employer contributions—and imposed mandates on individuals to purchase coverage and for employers to offer it.

Yet, large swaths of the public do not, in fact, want their private health coverage turned into a regulated public utility.

Furthermore, that opposition has grown and hardened as more Americans personally experience negative effects from the law, such as higher premiums and deductibles and reduced plan choices and provider access.

Making matters worse, Obamacare destabilized the individual insurance market by allowing people to wait until they need medical care to enroll in coverage. The resulting adverse selection further drove up premiums, as the law’s “carrot-and-stick” approach of low-income subsidies coupled with a fine for not buying coverage failed to enroll enough healthy individuals.

In short, the “why” of repealing Obamacare is the need to undo the law’s regulatory takeover of private insurance and to reverse its cost-increasing effects. Viewed from that perspective, the “what” in the House bill, even in its latest iteration, still misses the mark.

While the current legislation would repeal several of Obamacare’s insurance regulations—such as the age-rating restrictions that artificially increase premiums for young adults—it still leaves in place a number of the law’s federal coverage mandates.

Aside from the costs that they add to premiums, the coverage mandate provisions are the centerpiece of Obamacare’s regulatory commandeering structure. Fundamentally, they are a shift in control over health plan design to the federal government.

As long as they remain in place, they not only preempt the ability of states to better regulate their insurance markets, but also serve as the scaffolding for additional federal requirements to be imposed on private health plans in the future.

Furthermore, the House bill also does not adequately remedy the adverse selection problems created by Obamacare.

What is needed is for the legislation to make the ban on pre-existing condition exclusions contingent upon individuals maintaining continuous coverage—the same rules that Congress established for employer group coverage 15 years before Obamacare.

That is the best way to reward responsible people who do the right thing, while dissuading the less responsibly inclined from waiting until they need medical care before enrolling in health insurance.

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Despite Stern Warning From Trump, Conservatives Continue to Oppose Obamacare Bill

House conservatives are holding their ground in opposing the GOP’s health care bill, even after leaders made additional changes to the plan in an attempt to find middle ground and President Donald Trump delivered a stern warning to the conference Tuesday morning.

Republicans released their changes to their health care bill Monday night, which were rolled out in an effort to boost support from the House’s conservative and centrist members who oppose the Obamacare repeal plan, called the American Health Care Act.

The bill now gives states the option to choose between federal block grants for Medicaid or caps on how much in Medicaid funds is allotted to them per person.

It also gives states the option to implement Medicaid work requirements. And it moves up a repeal of Obamacare’s taxes to this year, increases the Medicaid inflation adjustment for the elderly and disabled, creates a reserve fund to boost tax credits for the low-income elderly, and makes Medicaid changes for New York.

Republican leaders are working to muscle the bill through the House, which is slated to vote on the plan Thursday, and they brought in Trump to close the deal.

Trump, meeting with GOP lawmakers behind closed doors, issued a warning: Pass the bill repealing and replacing Obamacare, or lose your seats and the House majority in 2018, according to reports.

The president also took to calling out by name Republican lawmakers who oppose the legislation. During the meeting, Trump addressed Freedom Caucus Chairman Mark Meadows, R-N.C., who supported the president during the campaign but whose group of roughly 40 conservative House members has the power to derail Thursday’s vote.

“Oh, Mark, I’m coming after you,” Trump told Meadows in jest. “I hope Mark will be with us in the end.”

Leaving the meeting at the Capitol, the president told reporters he was optimistic the health care bill would pass the House on Thursday.

“I think we’ll have a winner vote. We’re going to have a real winner,” Trump told reporters. “It was a great meeting. These are terrific people, and they want a tremendous health care plan, and that’s what we have, but there are going to be adjustments made. But I think we’ll get the votes on Thursday.”

But Trump’s hard-charging message to conservatives who oppose the legislation didn’t convince some members of the Freedom Caucus.

Meadows told reporters after the meeting that he still opposes the bill, despite Trump singling him out at the meeting.

“I’m still a ‘no’ because the bill we’re currently considering does not lower [health insurance] premiums for the vast majority of Americans,” Meadows said.

Rep. Jim Jordan, R-Ohio, who previously chaired the Freedom Caucus, also said that despite Trump’s warning, he, too, still opposes the legislation.

Freedom Caucus member Rep. Dave Brat, R-Va., said the GOP’s health care bill doesn’t do anything to solve “the primary problem,” the price of premiums.

“Obamacare played almost exclusive attention to coverage. The CBO and this current bill pay attention to coverage, but people have coverage, and they can’t get health care,” Brat, who opposed the bill in the House Budget Committee, told The Daily Signal. “You have coverage, but you have an $11,000 deductible in the bronze-level plan, so you can’t go access health care, and that’s a problem.”

Brat said during the meeting, Trump “put on a solid sales pitch” and said he wanted to pass the health care bill so Congress could move on to other priorities such as tax reform. But, the Virginia Republican said, the GOP has to “make sure we get this part of the economy right.”

In addition to the Freedom Caucus, other lawmakers have come out in opposition to the bill despite Trump’s arm-twisting.

Freshman Rep. Ted Budd, R-N.C., said in a statement today he couldn’t support the GOP’s health care plan.

“This bill leaves the structure of Obamacare in place and does not provide the relief that North Carolina families need from high premiums,” he said.

And Rep. Lou Barletta, R-Pa., took to Twitter to restate his intent to vote against the bill.

Heading into the final few days before the House is set to vote on the bill, Republican lawmakers are facing pressure from all sides of the Obamacare repeal debate.

While Trump is urging the GOP to pass the health care bill, conservative groups are urging lawmakers to vote against it.

Heritage Action for America, the lobbying affiliate of The Heritage Foundation, issued a “key vote” against the bill Thursday.

Additionally, Club for Growth launched an ad campaign targeting 10 centrist Republicans and urging them to oppose what it called “Ryancare.”

“Republicans promised a bill that would stop Obamacare’s taxes and mandates, and replace them with free-market reforms that will increase health insurance competition and drive down costs,” Club for Growth President David McIntosh said in a statement. “Ryancare fails on those counts.”

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House Conservatives: Obamacare Repeal Bill Still Needs Major Changes

Members of the House Freedom Caucus said the leadership-backed Obamacare repeal legislation, which is slated to go to vote Thursday, is far from where it needs to be to gain their support and lacks the votes to pass the lower chamber.

The powerful conservative group was joined by GOP Sens. Rand Paul of Kentucky, Ted Cruz of Texas, and Mike Lee of Utah—who have also voiced opposition to the bill—at its caucus meeting Monday, where they discussed their stance on health care reform.
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Changes to the legislation are expected to be rolled out in the form of a manager’s amendment before midnight. But according to Freedom Caucus Chairman Mark Meadows, who had not seen the amendment as of 9:30 p.m., the language he was told it contained is not enough to sway caucus members.

“Based on what I’ve been told is in the manager’s amendment and what I shared with the members tonight, I don’t think that it moves anybody or makes a compelling case to move anybody from where their previous position were,” he told reporters after the meeting.

The group has repeatedly expressed concerns about the legislation, railing against its language on tax credits, the 30 percent increase in premiums for those who drop coverage, and its timeline on rolling back Medicaid expansion. While leadership said adjustments will continue to be made as the Rules Committee has not yet marked up the bill, Meadows said the Freedom Caucus has been told the amendments they plan to put forward likely won’t be taken seriously by the bill’s proponents.

“Well, that’s not to say, that’s not to say that there is obviously a whole lot of discussions that are going on and you know if meaningful changes happen—we’ve been trying to negotiate in good faith,” he continued. “We’ve been led to believe that there are no more amendments that will be allowed that substantially change things, and so if that’s the case I think it makes it very difficult, if not impossible, to get to 216 tomorrow.”

Meadows said the legislation still needs substantial changes, as votes on individual amendments the group puts forward have the potential to be shot down on the floor.

“I mean, you know we know how that works—this is not everybody’s first rodeo. You make them in order and then vote them down on the floor,” he said. “It needs to change the bill. I mean really this is not about a bill and about a win or a loss here on Capitol Hill—it’s about a win or a loss back home on Main Street.”

President Donald Trump is expected to make an appearance at the House GOP conference meeting Tuesday in an attempt to sway members to vote for the legislation.

Michigan Rep. Justin Amash said he’s prepared to stand by his position on the legislation if changes aren’t made, even if he faces immense pressure from the president.

“I’ve been yelled at before,” he told reporters, adding the group has made suggestions to leadership throughout the process. “If they don’t want to accept those suggestions then that’s on them.”

Negotiations will continue, said Meadows, a North Carolina Republican, noting leadership has continued to ask what it will take to get them to yes. He said he’s hopeful they will reach a consensus before the bill comes to the floor.

“I think that cooler heads will prevail and we will find a way to get to yes with some reasonable amendments that are negotiated in good faith negotiations,” he said.

Despite the divide, leadership remains optimistic a consensus will be reached on the measure. House Majority Leader Kevin McCarthy of California told The Daily Caller News Foundation there are no plans to push back Thursday’s vote ahead of the Freedom Caucus meeting.

Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact licensing@dailycallernewsfoundation.org.

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House Conservatives: Obamacare Repeal Bill Still Needs Major Changes

Members of the House Freedom Caucus said the leadership-backed Obamacare repeal legislation, which is slated to go to vote Thursday, is far from where it needs to be to gain their support and lacks the votes to pass the lower chamber.

The powerful conservative group was joined by GOP Sens. Rand Paul of Kentucky, Ted Cruz of Texas, and Mike Lee of Utah—who have also voiced opposition to the bill—at its caucus meeting Monday, where they discussed their stance on health care reform.
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Changes to the legislation are expected to be rolled out in the form of a manager’s amendment before midnight. But according to Freedom Caucus Chairman Mark Meadows, who had not seen the amendment as of 9:30 p.m., the language he was told it contained is not enough to sway caucus members.

“Based on what I’ve been told is in the manager’s amendment and what I shared with the members tonight, I don’t think that it moves anybody or makes a compelling case to move anybody from where their previous position were,” he told reporters after the meeting.

The group has repeatedly expressed concerns about the legislation, railing against its language on tax credits, the 30 percent increase in premiums for those who drop coverage, and its timeline on rolling back Medicaid expansion. While leadership said adjustments will continue to be made as the Rules Committee has not yet marked up the bill, Meadows said the Freedom Caucus has been told the amendments they plan to put forward likely won’t be taken seriously by the bill’s proponents.

“Well, that’s not to say, that’s not to say that there is obviously a whole lot of discussions that are going on and you know if meaningful changes happen—we’ve been trying to negotiate in good faith,” he continued. “We’ve been led to believe that there are no more amendments that will be allowed that substantially change things, and so if that’s the case I think it makes it very difficult, if not impossible, to get to 216 tomorrow.”

Meadows said the legislation still needs substantial changes, as votes on individual amendments the group puts forward have the potential to be shot down on the floor.

“I mean, you know we know how that works—this is not everybody’s first rodeo. You make them in order and then vote them down on the floor,” he said. “It needs to change the bill. I mean really this is not about a bill and about a win or a loss here on Capitol Hill—it’s about a win or a loss back home on Main Street.”

President Donald Trump is expected to make an appearance at the House GOP conference meeting Tuesday in an attempt to sway members to vote for the legislation.

Michigan Rep. Justin Amash said he’s prepared to stand by his position on the legislation if changes aren’t made, even if he faces immense pressure from the president.

“I’ve been yelled at before,” he told reporters, adding the group has made suggestions to leadership throughout the process. “If they don’t want to accept those suggestions then that’s on them.”

Negotiations will continue, said Meadows, a North Carolina Republican, noting leadership has continued to ask what it will take to get them to yes. He said he’s hopeful they will reach a consensus before the bill comes to the floor.

“I think that cooler heads will prevail and we will find a way to get to yes with some reasonable amendments that are negotiated in good faith negotiations,” he said.

Despite the divide, leadership remains optimistic a consensus will be reached on the measure. House Majority Leader Kevin McCarthy of California told The Daily Caller News Foundation there are no plans to push back Thursday’s vote ahead of the Freedom Caucus meeting.

Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact licensing@dailycallernewsfoundation.org.

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Nearly 200 State Lawmakers Are Pushing for Changes to GOP Obamacare Repeal Plan

As House Speaker Paul Ryan works to satisfy the concerns of conservative and more liberal Republicans opposed to the GOP’s Obamacare replacement plan, more than 180 state lawmakers are joining the chorus of voices with issues with the bill.

The state legislators, who represent 25 states, sent a letter to Ryan and Senate Majority Leader Mitch McConnell last week conveying their concerns with the Medicaid expansion and laid out changes they’d like to see made to the health care bill.

“This bill offers a historic opportunity for reform, but without some changes to the bill we fear the opportunity might slip away,” the lawmakers wrote.

The state lawmakers specifically take issue with the health care proposal’s plan for phasing out the Medicaid expansion.

The House GOP’s bill, called the American Health Care Act, sunsets Medicaid expansion in 2020.

Until then, states can continue enrolling those who are newly eligible under enhanced federal matching rates. But after 2020, states that continue signing up new enrollees under the Medicaid expansion would receive the traditional federal matching rates, which average 57 percent.

But the lawmakers in statehouses nationwide worry that the bill doesn’t go far enough with repealing Obamacare’s Medicaid expansion, which extended the program to individuals making up to 138 percent of the federal poverty line.

“We have this Medicaid expansion that’s growing at an unsustainable rate with money that’s not going to come from Washington,” Ohio state Rep. Wesley Goodman, R-Cardington, told The Daily Signal. “Give us the flexibility to make the program work for people who need it.”

Goodman and fellow lawmakers who signed the letter urged GOP leaders to make four changes to the bill: freeze enrollment in Medicaid expansion, eliminate enhanced federal matching rates for new Medicaid enrollees, prohibit new states from expanding Medicaid, and repeal Obamacare’s insurance regulations.

The letter from state lawmakers comes just days before members of the U.S. House of Representatives will vote on the health care bill—lawmakers are expected to cast their vote on the plan to undo parts of Obamacare on Thursday, exactly seven years after President Barack Obama signed the Affordable Care Act into law.

And Ryan, the House’s top Republican, has been left to walk a fine line between Republicans at different levels of government who oppose the bill for different reasons.

At the federal level, conservatives in Congress have advocated for phasing out the Medicaid expansion by the end of the year. They also say they believe the health care bill does nothing to lower the cost of premiums, since the plan leaves in place the insurance regulations conservatives believe have caused premiums to rise over the last three years.

Centrist Republicans, meanwhile, have said they want to ensure those who are newly enrolled in Medicaid expansion are able to maintain their coverage and are pushing for changes to the age-based tax credits the bill creates.

In their own letter to Ryan and McConnell, four GOP governors who oversee states that expanded Medicaid want to see the expansion preserved.

But state lawmakers say they want Republican leaders to fully repeal the Medicaid expansion.

“It’s important that we send as clear a message as possible that states and state legislators are paying attention,” Goodman, who previously worked for Rep. Jim Jordan, R-Ohio, said of the letter to Republican leaders.

“We have a lot of skin in the game, and we want them to give us the tools to actually allow a health care marketplace to grow and thrive,” he continued.

At the start of the 115th Congress in January, House Majority Leader Kevin McCarthy, the House’s No. 2 Republican, said he and other Republican leaders would be soliciting advice from governors and stakeholders at the state level.

Already, the Trump administration is attempting to give states more control over their health insurance markets.

Last week, Health and Human Services Secretary Tom Price sent a letter to governors urging them to apply for Section 1332 State Innovation waivers, which allow states to pursue new approaches to health care.

Goodman said Ohio will likely pursue such a waiver this year, but said he is also hoping Congress turns Medicaid into a block grant program, which the House GOP’s health care plan proposes.

“Give us the flexibility to spend that money,” he said.

Though the House is just days away from voting on the health care bill, Goodman said he believes changes can still be made to the legislation that satisfies his and other state lawmakers’ concerns.

“I’ve been around long enough and watched enough of these federal debates to know this is a long way from over,” Goodman said. “There’s still a lot of moving parts. Lawmakers in Washington need to hear from their counterparts in the states saying we can do better than this and we will do better than this. That’s the message we have, and we’re going to keep up with that message until it’s on the president’s desk.”

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