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 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
conservative opponents.
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 the Medicaid government health insurance
program for the poor.
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.
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 faces opposition from leading healthcare providers,
including doctors and hospitals.
"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.
'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.
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Conservatives want a quicker end to the Obamacare Medicaid
expansion, 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 entitlement.
The White House said it was discussing changes with House Republican
leaders. 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.
Conservative advocacy groups praised the Republicans who voted "no."
Club for Growth President David McIntosh said it makes no sense for
Ryan and Budget Committee chair Diane Black to force Republicans "to
walk the plank and vote for a bad bill that they've already admitted
needs to be changed."
Black asked fellow Republicans who had doubts not to "cut off the
discussion" by voting no.
After approving the legislation, the panel adopted four non-binding
Republican recommendations for changes before it moves to the House
floor, including one by the conservative Palmer on adding work
requirements for able-bodied, childless Medicaid recipients.
The other recommendations called for no longer encouraging people to
sign up for insurance through Medicaid, giving states more
flexibility in designing Medicaid programs, and changing the bill's
tax credits to help lower-income people more.
Democrats have called the Republicans' plan a blow to the elderly
and the poor while giving tax cuts to the rich.
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."
(Additional reporting by Susan Heavey, Doina Chiacu, David Morgan
and Yasmeen Abutaleb; Writing by Will Dunham; Editing by Dan Grebler)
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