President Donald Trump and the Republican’s in Congress have been working overtime on ways to repeal and replace Obamacare. But Monday night the Conservatives in the House Freedom Caucus voted among themselves to band together and support only an Obamacare repeal that is at least as aggressive as a bill the House and Senate passed in 2015, putting GOP leaders in a bind with their conference and perhaps even threatening the possibility of passing a repeal of the Affordable Care Act at all.
This all is happening as town hall meetings around the country where both Republican and Democratic lawmakers were being peppered with questions about the future of Obamacare.
For those unaware who he Freedom Caucus are, it is a group of roughly 35 to 40 House conservatives. Monday night they voted to take this official position. The vote came at a time when the majority of the Republicans, in Congress have been leaning in the direction of repairing the law rather than totally repealing it.
The Freedom Caucus wants immediate repeal of Obamacare and they feel that it would force both the Republicans as well as the Democrats to the bargaining table to craft some replacement items that would be in line with the 2015 bill that was passed by both houses of Congress.
The more moderate members of the GOP feel that would cause too much uncertainty in the minds of the voters.
The 2015 repeal bill, which kills the core elements of the law including its subsidies, taxes, mandates and Medicaid expansion, to be brought up again.
Tuesday morning the House Republican leaders tried to present a unified front in a news conference. They insisted that the concerns of everyday Americans are being heard and addressed. “I can’t tell you how many families, how many small businesses, how many patients have been hurt by the Affordable Care Act,” Ways and Means Committee Chairman Kevin Brady said, adding that his fellow Republican’s are “working to provide relief to the families that have been damaged by Obamacare.”
Majority whip Steve Scalise cheered public disagreements between Republican lawmakers as democracy in action, describing the intra-party debate as an open, transparent process. House Speaker Paul Ryan, too, attempted some damage control, signaling that the party is taking Obamacare protests seriously. “I fully recognize and respect the strong feelings that people have about this issue. We should be passionate about this issue—it is about people’s lives,” he said. “That is why we are taking a step-by-step approach so that people can see the changes that we are making, so they can see how they will help.”
The more moderate wing of the Republican Party and President Trump, are concerned that states who expanded Medicaid are wary of losing extra federal funds if the expansion were repealed, and of the possibility that their constituents could lose their insurance coverage the moment the law is repealed.
The Freedom Caucus seems to be open to the possibility of a provision on Health Savings Accounts, but wariness of the idea of adding a tax credit. Opposition to a tax credit also could be a major hurdle, given that tax credits are at the center of most Republican replacement plans.
Another problem for GOP lawmakers is removal of the Medicaid expansion that is popular in many red states. Vice President Mike Pence, supported expansion as the governor of Indiana, as did Gov. John Kasich of Ohio, Chris Christie of New Jersey,
Another key reason the GOP members of Congress are not likely to abandon the expansion issue is what voters want. Thirteen states that voted for President Trump in the November election had Medicaid expanded under the ACA, including the majority of the “swing states,” that were key to getting the new president elected.
Medicaid is responsible for a significant part of health care coverage in the U.S. In 2015, roughly 20 percent of Americans were covered through the program, according to the Henry J. Kaiser Family Foundation. In total, there are some 75 million adults and children in the U.S. who are currently insured through Medicaid and its related Children’s Health Insurance Program (CHIP).
President Trump appointed Seema Verma as the new head of CMS, and she recommended for that post by her former boss Vice President Pence. She is most widely known for her role as the architect of the Healthy Indiana Plan. She worked closely with then Gov. Pence to craft the state’s version of Medicaid expansion under the ACA. She worked with the former President Barack Obama administration to get Indiana a waiver the program, nicknamed HIP 2.0, in 2015.
Verma, worked closely with a number of states including Ohio and Kentucky to craft new Medicaid expansion deals with the Obama administration. According to CNBC. “She was a very good listener and was able to put a lot of different perspectives into the mix,” said Sarah Stelzner, MD, a pediatrician with Indianapolis-based Eskenazi Health, according to the report.
The hard line Conservative Freedom Caucus members are setting up a massive battle within the Republican Party. For now, the key person in this drama is Speaker Ryan who must work out a replacement for Obamacare that President Trump can back and at the same time will make the Freedom Caucus happy. That will test every bit of Speaker Ryan’s bit of political skills.