Republicans split, conservatives angry as U.S. healthcare overhaul inches ahead

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By Susan Cornwell | WASHINGTON

WASHINGTON Deeply divided Republicans squeezed
their U.S. healthcare overhaul, backed by President Donald
Trump, through a key House of Representatives panel on Thursday
despite defections by three conservatives who consider it too
similar to the Obamacare law it is intended to replace.

Trump’s first major legislative initiative still faces an
uphill battle in the full House and later the Senate despite
ongoing efforts by the White House and Republican leaders to
satisfy conservatives.

The Budget Committee vote was 19 to 17, with Republican
Representatives David Brat, Gary Palmer and Mark Sanford – all
members of the conservative House Freedom Caucus – joining the
panel’s Democrats in voting against it. The committee brought
provisions approved last week by two other panels into a single
bill, helping pave the way for a later vote on the House floor.

Republicans, who control Congress and the White House, could
not afford to lose more than three from their ranks on the
committee for it to pass.

“I don’t think we are anywhere near passage,” Brat said
after the vote, noting that Republican conservatives as well as
moderates had problems with the bill.

The 2010 Affordable Care Act, the signature legislative
achievement of former President Barack Obama, enabled about 20
million previously uninsured Americans to obtain medical
coverage. About half of those were through the law’s expansion
of eligibility and increased funding for Medicaid.

The close vote illustrated the problems Republican leaders
may encounter in corralling enough votes in their party to win
passage on the House floor amid unified Democratic opposition.
The measure now goes to the Rules Committee before reaching the
House floor.

“We are on track and on schedule,” House Speaker Paul Ryan,
who unveiled the legislation last week and is its chief champion
in the House, said after the committee’s vote. He added that
while the main parts of the bill “are going to stay exactly as
they are,” Republicans were making unspecified “improvements and
refinements.”

Ryan told a news conference that Trump was “deeply involved”
and “helping bridge gaps” among Republican lawmakers to get a
consensus plan.

The Congressional Budget Office, a nonpartisan congressional
agency, forecast on Monday that the legislation would increase
the number of Americans without health insurance by 24 million
by 2026, while cutting $337 billion from federal budget deficits
over the same period. The bill also faces opposition from
leading healthcare providers, including doctors and hospitals.

‘CONSTITUENCY OF ONE’

Conservatives were unmoved. “There’s no natural constituency
for this bill,” said Republican Representative Raul Labrador,
another Freedom Caucus member.

“The Left is really mad about it. The Right is really mad
about it. The middle is really mad about it. And so far it just
seems to be a constituency of one, which is Washington insiders,
people that are just trying to get something passed so they can
get to the next issue.”

Trump administration officials and House Republican leaders
have said they hope to get the bill to the House floor by the
end of the month so it can go to the Senate before lawmakers’
mid-April recess.

Conservatives want a quicker end to the Obamacare expansion
of the Medicaid health insurance program for the poor, which the
bill has set for 2020, and want to add work requirements for
some Medicaid recipients. They also call the age-based tax
credits to help people buy insurance on the open market an
unwise new federal entitlement.

The White House said it was discussing changes with House
Republican leaders.

“There’s no perfect piece of legislation. There’s gonna be
this framework that’s gonna be added to or subtracted to during
the process, and eventually it’s going to pass the House and
it’s going to pass the Senate,” White House budget chief Mick
Mulvaney told Fox News on Thursday.

Trump told a Fox News interviewer on Wednesday that much of
the bill would still be negotiated, especially as it moves from
the House to the Senate.

Republican Representative Diane Black, who heads the budget
committee, asked Republicans who had doubts not to “cut off the
discussion” by voting no.

Conservative advocacy groups praised the three Republicans
who voted “no.” “It makes no sense for Speaker Ryan and Chairman
Diane Black to force GOP (Republican) lawmakers to walk the
plank and vote for a bad bill that they’ve already admitted
needs to be changed,” Club for Growth President David McIntosh
said.

Representative John Yarmuth, the committee’s top Democrat,
said the legislation was “not a healthcare bill; it is an
ideological document.” He said the bill imagined a “fantasy land
where young people don’t get sick, and apparently they don’t
grow old either, because they don’t have to worry about being
priced out of the market.”

Democrats have called the Republicans’ plan a blow to the
elderly and the poor while giving tax cuts to the rich.



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