The White House on Friday won support from conservative Republican Study Committee (RSC) leaders by agreeing to give states the option to impose work requirements on Medicaid recipients and to block grant Medicaid instead of the cap system in the bill.
GOP leaders are using the RSC endorsement — and new words of support from President Trump — to try to build momentum for the measure.
But the far-right Freedom Caucus is still largely opposed to the measure, and there are still serious doubts about whether the bill has enough votes to pass yet.
In addition to the Medicaid agreement with the RSC, the White House and House leaders are also eyeing increasing the tax credits in the bill, something that could bring centrists on board.
Centrist Republicans have been pushing for changes to the tax credits in the bill so that they would give more financial help to low-income people and older people, whom they worry would not be given enough help to afford coverage under the current bill.
Conservatives also want to see changes to tax credits. Rep. Robert Aderholt (R-Ala.), one of 13 RSC members called to the White House on Friday, said President Trump gave him a firm commitment he'd address concerns that tax credits central to the GOP bill are too small to ensure coverage is affordable for some people.
Aderholt told Trump that 80 percent of his district supported him in the election. But the conservative congressman explained that many of his constituents are low-income and elderly and would see enormous hikes in their premiums under the GOP bill.
“I understand those are people who supported me, and we’re not going to let them down,” Trump replied, according to Aderholt. Then he turned to some of his aides in the room and said, “This is going to be taken care of.”
In an extreme example under the current bill, the premium for a 64-year-old making $26,500, after factoring in financial assistance, would rise from $1,700 to $14,600 under the GOP plan.
Earlier Friday, Health and Human Services Secretary Tom Price huddled with House Republicans in a closed-door meeting and told them that changes to the tax credits are a possibility.
“The Speaker said this a minute ago, he didn't say the specifics of it, but he said that some tweaks will be made to the tax credits and probably that's the older — old geezers like me that are 55 and up,” Rep. Phil Roe (R-Tenn.) said while leaving a House Republican Conference meeting Friday morning.
But the far-right Freedom Caucus still has strong objections to the bill. Its chairman, Rep. Mark Meadows (R-N.C.), took issue with work requirements being optional, saying that provision only moves the ball “a couple of yards” down a very large field.
In an interview filmed for C-SPAN's "Newsmakers,” Meadows said that there are at least 40 House Republicans who are opposed to the legislation, plus another 20 to 30 who are undecided.
The Freedom Caucus chairman made his comments before House GOP leaders announced Friday they were making modifications to the GOP bill.
A Freedom Caucus source on Friday afternoon said the conservative group “remains opposed” to the bill in its current form.
“Today's announcement of the RSC's support for the bill doesn't change that,” the source said. “If the bill were brought to the floor today, it would fail to get enough votes."
Scalise, who was in the White House meeting, is looking to Trump’s support to bring on additional lawmakers, arguing that the president has increased his backing for the bill after Friday’s changes.
“A lot of members were saying the president's talking about an open negotiation, which means he's not yet ready to sign onto this bill,” Scalise said. “What President Trump said very clearly this morning in the Oval Office is with these changes, I am 1000 percent for the bill and I want members to vote for it.”
Trump told reporters: "I want people to know ObamaCare is dead; it's a dead healthcare plan.”
Some centrist lawmakers like Rep. Charlie Dent (R-Pa.) say that they want to see a new Congressional Budget Office (CBO) analysis of the bill before the vote.
But Scalise declined to commit to having a new CBO score before the vote.
“Obviously CBO works a lot slower than we'd like but that's OK, that's their method,” Scalise said, “but we're moving forward with our bill because the American people want relief from ObamaCare.”
- Bob Cusack and Ben Kamisar contributed.
