After 27 hours of debate, the House Energy and Commerce Committee on Thursday approved its half of the House GOP's plan to repeal and replace the Affordable Care Act, but the bill's future remains uncertain as conservative lawmakers continue to object to key provisions.
Lawmakers had divided the House Republican plan, called the American Health Care Act (AHCA), into two parts for separate markup by the Energy and Commerce Committee and the Ways and Means Committee. The Ways and Means Committee previously approved its portion of the bill, which related to tax provisions.
The bill now heads to the House Budget Committee, which is scheduled to begin uniting the committee-approved bills on Wednesday, the Washington Times reports. According to the Washington Post's "PowerPost," the bill remains on track to reach the full House by the end of the month.
But major obstacles remain to the bill's passage: Members of the conservative House Freedom Caucus on Tuesday said the repeal and replace plan lacked the votes necessary for approval.
Conservative Republicans push for changes
According to Politico, the two main conservative groups—the Republican Study Committee (RSC) and the House Freedom Caucus—are at odds on what concessions are needed for their members to support the House GOP's ACA replacement bill.
RSC, which includes about 170 conservative lawmakers, is backing two proposals. The first, by Rep. Joe Barton (R-Texas) and Marsha Blackburn (R-Tenn.), would freeze Medicaid enrollment under ACA's expansion starting in 2018, as opposed to the 2020 date in the current bill. The second, by Rep. Morgan Griffith (R-Va.), supports a Medicaid work requirement for able-bodied adults who do not have children. The group also is pushing to restructure the tax credits proposed in the bill.
RSC Chair Mark Walker (R-N.C.) said, "While I continue to have concerns about this bill, the adoption of these amendments would be a critical step in the right direction."
But members of the Freedom Caucus have said those changes would not be enough to gain the group's support. Griffith, a Freedom Caucus member, played down the significance of his own work-requirement proposal, saying, "I think it's a lump of sugar for a three-lump coffee drinker."
Trump, Ryan send mixed signals
Further, some conservative lawmakers said President Trump and House Speaker Paul Ryan (R-Wis.) are sending mixed signals on how they will address conservatives' concerns, "PowerPost" reports.
Rep. Mark Sanford (R-S.C.) said, "What we hear from the White House is, this is a work in progress. Then we hear from leadership, take it or leave it."
Ryan during his weekly press conference on Thursday delivered a 23-minute presentation in which he sought to sell conservatives and the public on the House's current plan. "This is the closest we will ever get to repealing and replacing Obamacare. The time is here. The time is now," Ryan said, adding, "It really comes down to a binary choice" between voting for the House bill or leaving the ACA in place.
However, after leaving a meeting with Trump on Thursday, Meadows said, "I didn't hear anything that said it's a binary choice at the White House today."
Meanwhile, senators are increasingly discussing whether they would amend the House GOP's ACA replacement if it reaches their chamber, Roll Call reports.
According to "PowerPost," Senate Republicans on Thursday voiced concerns about the pace at which House lawmakers are advancing the bill, saying it is unlikely to pass the Senate in its current form.
Senate Republican Conference Chair John Thune (R-S.D.) said, "There are lots of ways you can fix and amend the bill," adding, "Then it would have to go back to the House obviously, but I wouldn't rule that out. I just think you've got to have an opportunity for members of the Senate to have their input into it."
However, Senate Finance Chair Orrin G. Hatch (R-Utah) on Wednesday said the legislation, if approved by the House, would bypass his panel and go straight to the Senate floor as part of the reconciliation process.
Some senators also have floated a controversial move to change Senate reconciliation rules to allow for debate on provisions that would not significantly affect the federal budget. Bills passed through reconciliation can be approved by a simple majority but they must be related to federal spending and revenues (Howell, Washington Times, 3/9; DeBonis, "PowerPost," Washington Post, 3/9; Siddons, CQ News, 3/9 [subscription required]; Williams/Young, CQ News, 3/9 [subscription required]; Haberkorn/Bade, Politico, 3/9; Bade/Cheney, Politico, 3/9; Lesniewski, Roll Call, 3/9).
What you need to know about the House GOP's repeal and replace plan
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