President Trump met Friday with House Republican leaders to discuss their effort to pass a sweeping overhaul of the Affordable Care Act, amid mounting criticism from conservatives urging them to go further.
In brief comments to reporters at the start of the meeting, Trump congratulated the leaders for advancing their legislation through two committees this week and voiced optimism about the road ahead.
“This is the time we’re going to get it done,” said Trump. “We’re working together. We have some great results. We have tremendous spirit. And I think it’s something that’s just going to happen very shortly.”
But there were fresh signs of discord earlier Friday when House GOP leaders dismissed the suggestion from conservative members that their proposed phaseout of the ACA’s Medicaid expansion should be moved up by two years — from 2020 to 2018.
“I think right now that would be very difficult to do,” said House Majority Leader Kevin McCarthy (R-Calif.) at a news conference on Capitol Hill.
The White House meeting came at the end of a week in which a showdown quickly erupted between the most conservative members of Congress and House GOP leaders. Both sides have been speaking to Trump and hoping he will help them wear down the other side, putting the president at the center of a fierce intraparty clash.
McCarthy was joined at his news conference by the House GOP lawmakers taking the lead on shepherding the bill through the lower chamber, some of whom took part in Friday’s White House meeting. They outlined their next steps in repealing and replacing key parts of the ACA. Their attempt has come under attack from both ends of the political spectrum.
“Some have said that this legislation doesn’t do enough,” said Rep. Diane Black (R-Tenn.), who chairs the House Budget Committee. The panel is expected to work on the bill next week. She added, “It zeros out the mandate, it repeals the taxes, it repeals the subsidies, and it rolls back some of the regulations.”
McCarthy argued that because of the power the minority party holds in the Senate, the American Health Care Act, as the GOP bill is known, is the most aggressive plan Republicans can spearhead right now. He said that it was just one of three phases in reshaping health-care laws that will also later involve Health and Human Services Secretary Tom Price taking actions from the executive branch.
In a Friday radio interview with conservative host Hugh Hewitt, House Speaker Paul D. Ryan (R-Wis.) warned that any deviation from the plan set in motion would be “momentum killing.”
The notion of accelerating the Medicaid expansion phaseout was formally recommended Thursday by the Republican Study Committee, an influential conservative caucus. Leaders of the House Freedom Caucus, another conservative group, discussed it in a White House meeting with Trump and other senior administration officials.
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, said changing the phaseout date would upset a carefully crafted bill that was negotiated with key parties off Capitol Hill.
“I’ve had discussions all along about different dates, different timelines with governors, with insurance commissioners, with leaders of each of these different groups,” Walden said. “What we want to make sure is that we don’t create a gap. . . . Our best effort is what you see before us.”
McCarthy also said Friday that other pieces of health-care legislation — bills that aren’t constrained by special Senate budget rules and thus will need some Democratic support in that chamber — could also move through the House at about the same time as the broader package.
Friday’s White House meeting came the day after the House GOP proposal to revise the ACA claimed its first major victories. The bill cleared the Ways and Means and the Energy and Commerce committees on party-line votes after lengthy sessions that lasted through Wednesday night and into Thursday.
During their Thursday meeting with Trump and White House Budget Director Mick Mulvaney, Freedom Caucus members Mark Meadows (R-N.C.) and Jim Jordan (R-Ohio) expressed concerns about the current House plan, including how it addresses the Medicaid, said a person familiar with the gathering, speaking anonymously to reveal details of a private conversation.
Trump expressed an openness, this person said, to moving the Medicaid rollback earlier than the 2020 date in the current bill, but did not offer a “hard and fast” commitment.
Under the ACA, 31 states and the District of Columbia accepted an expansion of Medicaid to cover more people. The House GOP proposal would administer Medicaid by giving per capita funding to states, instead of offering it as an open-ended program. The plan would also replace federal insurance subsidies in the ACA with age- and income-based tax credits.
Rep. Joe Barton (R-Texas), the vice chairman of the Energy and Commerce Committee, offered an amendment at the marathon panel meeting Thursday that would speed up the Medicaid expansion phaseout. He ultimately withdrew it but said Friday he expected to offer a similar amendment to the bill when it reaches the floor.
“He didn’t say it would be impossible,” Barton said, responding to McCarthy’s suggestion that moving the date would be difficult. The White House, he said, is “studying it.”
Conservatives remained split Friday over which element of the bill needed to change to win their vote. Some focused on rolling back Medicaid while others insisted the legislation must roll back requirements that insurers provide basic benefits, like pre-natal and maternity care.
“The number one priority, you can throw everything else away, is getting premiums down,” Meadows said.
Ryan and other leaders have often spoken about the GOP repeal and replace effort as happening in three phases — the special “reconciliation” bill that can pass the Senate with a simple majority, administrative actions by the Trump administration and traditional bills that will require 60 votes to pass the Senate.
“There’s other pieces of legislation that, yes, we will move during that third phase, and some of that phase can start during the week that we bring this to the floor,” McCarthy said. “Some bills can be on in the same week, and some won’t be prepared yet, and some bills will be after.”
Several conservatives, including Meadows and Rep. Justin Amash (R-Mich.) said they shouldn’t rely on Price to mandate some changes through regulations because they could easily be undone by future administrations.
“We can’t depend on a particular person to be in office for our laws to work,” Amash told reporters on Thursday. “If you are relying on the current HHS secretary to ensure that certain aspects of a country’s health-care law are being implemented, then you are making a mistake.”
Trump’s meetings with conservative critics of the plan this week — which have included leaders of acitivst groups who oppose the House bill — has signaled a willingness to negotiate its details and indicating that it does not yet have enough votes to emerge from the House.
More acknowledgment of the proposal’s problems has come this week from Senate Republicans, who have that the measure is moving too quickly through the House and in a form unlikely to succeed if it gets to the upper chamber.
The proposal also faces resistance from GOP moderates and Democrats who have expressed concerns that the bill would strip coverage and benefits from those who need it most.
Ashley Parker contributed to this story.