House GOP leadership faced mounting opposition Tuesday after introducing an Obamacare repeal and replace bill that was rejected by small government conservatives, panned by Republican moderates and given only lukewarm support from President Trump.
One day after unveiling the GOP's long-promised effort to dismantle the Affordable Care Act and replace it with something better, the new American Health Care Act already appears to be on life support, unlikely to survive the onslaught of friendly fire unless Trump personally rallies his party.
But Trump's intervention looks uncertain. While the president embraced "our wonderful new healthcare bill" in an early morning tweet, he also suggested it's just a starting point "for review and negotiation" — opening the floodgates to alternative ideas and proposals that could take weeks to sort out.
Later, in a White House meeting with House Republicans, he offered a stronger endorsement, saying he was "proud to support" their plan and expected it to pass "very quickly."
At the same time, though Trump is also accepting back-channel calls from conservative Republican opponents — including Sen. Rand Paul (R-Ky.) — who are warning him off legislation they view as nothing more than a revamped federal entitlement program. Conservative lawmakers are being backed by the Koch network, whose supporters rallied outside the Capitol on Tuesday, and other influential groups including Heritage Action and Club for Growth. They dismiss the GOP leadership's bill as "Obamacare 2.0" or "Obamacare lite."
"This is not the Obamacare repeal bill we've been waiting for," said Sen. Mike Lee (R-Utah), who is leading the GOP opposition with Paul and the House Freedom Caucus. Sen. Ted Cruz (R-Texas) has also raised objections.
"We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that," Lee said. "This is exactly the type of backroom dealing and rushed process that we criticized Democrats for, and it is not what we promised the American people."
For seven years Republicans have promised to end Obamacare, and after winning repeated congressional elections on their promise to repeal and replace the law, they were confident Democrats would have no choice but to join them.
But Democrats have shown no interest in the GOP bill, saying it would drop millions of Americans from healthcare coverage without offering them viable alternatives. Rather than being spooked by their November election losses, Democrats have been buoyed by the outpouring of support for Obamacare by constituents and protesters flocking to lawmakers' town hall meetings across the country.
"This Republican bill will do massive damage to millions of families across the nation," said Rep. Nancy Pelosi (D-San Francisco), the minority leader. She called it a "Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across America."
Without much backup, House Speaker Paul D. Ryan (R-Wis.) is nevertheless pressing forward with an ambitious committee hearing schedule Wednesday, ahead of an expected House vote this month. Senate Majority Leader Mitch McConnell (R-Ky.) said he expected passage in the Senate before the spring recess in April. But the GOP leaders are largely standing alone for now and will need more political muscle to heave the bill to passage.
The White House dispatched Vice President Mike Pence to Capitol Hill on Tuesday for his regular Senate Republican lunch and to meet with other GOP lawmakers, and Health and Human Services Secretary Tom Price told White House reporters he "looked forward" to working with critics on the bill. But it is increasingly clear Republicans will need more than the mild diplomacy of these two former congressmen to hammer resistant Republicans into line.
Republicans can afford to lose no more than about 20 lawmakers in the House and two in the Senate under special rules that allow passage of the legislation with a simple majority. Trump's bully pulpit would provide a stronger nudge.
"I like the president's statement that it's up for negotiation," Paul said on Fox News, adding he spoke to Trump on Monday. "The negotiation will be conservatives saying, 'Hey, we're not going to take Obamacare lite.'"
The architects of the House bill — Rep. Kevin Brady (R-Texas), chairman of the Ways and Means Committee, and Rep. Greg Walden (R-Ore.), chairman of the Energy and Commerce Committee — urged their colleagues Tuesday to give the bill a chance. They are also betting that few Republicans would want to be blamed for preventing the party's best chance to date at derailing Obamacare.
"We can act now or we can keep fiddling around and squander this opportunity," Brady said.
The Republican bill would dramatically revamp the Obamacare system by shifting healthcare costs away from the federal government and onto patients and states.
The GOP legislation ends the Obamacare subsidies that help some Americans buy health insurance and replaces them with monthly tax credits for consumers who buy their own insurance policies. Those credits, up to $14,000 a year for families, are phased out for individuals earning more than $75,000 a year or $150,000 for couples.
The Republican plan also phases out, in 2020, the expansion of Medicaid that some states chose to participate in under Obamacare, halting the federal funding that helps states pay for healthcare for the poor and disabled.
Dismantling the Medicaid expansion is particularly worrisome to GOP senators from Ohio, West Virginia, Colorado and Alaska because they fear their states will be unable to provide health coverage for needy residents.
"I want to be sure that during that transition period people aren't left high and dry," Sen. Rob Portman (R-Ohio) told reporters.
The bill keeps some popular provisions of Obamacare, such as allowing young adults to remain on their parents' plans until they are 26. But it does away with others, including one that restricts insurers from charging older patients for policies three times more than for younger people. The GOP bill allows older customers to be charged five times as much.
A full accounting of the costs and numbers of people who will gain or lose coverage is expected soon from the nonpartisan Congressional Budget Office, and some lawmakers criticized GOP leaders for pressing forward without that complete assessment.
Other Republican lawmakers, though, said the GOP plan would require Americans to budget their money more wisely rather than rely on the government for help.
The Republican plan will expand opportunities for Americans to sock more of their own money away into health savings accounts that can be used to pay for healthcare costs, they say.
"Americans [have] got to make a choice, and so maybe instead of getting that new iPhone ... they should invest in their own healthcare," said Rep. Jason Chaffetz (R-Utah).