Ryan concedes that GOP health care plan must change in order to pass House

House Speaker Paul Ryan said Wednesday that his health care proposal must change to pass the House, marking a significant retreat from his earlier position that the carefully crafted legislation would fail if altered.

The shift came after a private meeting of House Republicans from which Ryan, R-Wis., emerged to tell reporters that his proposal to revise the Affordable Care Act would “incorporate feedback” from the rank-and-file. Ryan attributed the change of strategy to the impact of an analysis issued Monday by the Congressional Budget Office. Among other details that prompted a fresh round of criticism of the proposal was a projection that 14 million fewer Americans would be insured after one year under the Republican plan.

Ryan backed away on Wednesday from his previous rhetoric of calling the measure’s fate a “binary choice” for Republican lawmakers.

“Now that we have our score … we can make some necessary improvements and refinements to the bill,” he said, referring to the CBO’s estimate of the impact on the number of those covered by health insurance and what the GOP proposal would cost.

Ryan did not detail what changes are under consideration.

Vice President Pence also spoke to House Republicans in the meeting, acknowledging that changes to the legislation – which heads to the House Budget Committee for approval Thursday – are in the works. President Trump has offered his support for Ryan’s measure, while still meeting with conservative lawmakers who have expressed serious doubts about the plan.

“This president is ready to put the full weight of his bully pulpit and all of his tools” behind the bill, Pence told Republicans, according to Rep. Kevin Cramer, R-N.D. “It was very important for us to hear that, because there are a lot of people who need that shoring up.”

“We are on the same page as the White House,” Ryan said. “I think there are those who would love to wedge us for one reason or another, but that’s just not the case.”

Hours later, at a rally for Obamacare opponents outside the Capitol, Sen. Ted Cruz, R-Texas, told activists that the House plan “has a lot of problems” but could possibly be modified into a “real repeal” of the ACA.

“I believe we can get it done,” Cruz said. “I can tell you, the last week, four days, I’ve been at the White House meeting with the president, with the vice president, saying, ‘We’ve got to get it done.'”

Various changes have been floated since the bill was unveiled earlier this month. Conservatives have pushed for an earlier phase-out of the ACA’s Medicaid expansion, moving it from the end of 2019 to the beginning of 2018, but GOP moderates in both the House and Senate have pushed back on that notion.

“Doing that would be a nonstarter and would be enormously and hugely problematic for many of our members,” said Rep. Charlie Dent, R-Pa., a co-chairman of the centrist Tuesday Group.

Meadows said Wednesday that the Freedom Caucus is closely focused on repealing more of the ACA’s mandates governing the extent of insurance coverage. “That is probably the No. 1 priority,” he said. “If we can get those, it would make the rest of it a whole lot easier.”

GOP leaders, however, have kept those provisions out of the pending legislation, arguing that their inclusion could threaten the bill’s passage in the Senate and that many of those mandates can be undone through Trump administration actions.

In another sign of the effect of the CBO report, Sen. John Thune, R-S.D., floated a proposal to recalibrate the tax credits established under the House bill to offer more substantial help to low-income Americans. The House bill would offer assistance to individuals making as much as $115,000 a year; Thune’s amendment would phase out aid for those making about $75,000 or more.

“We want to build on what the House has done, and we think that this amendment does that,” Thune said. “It just makes it more defensible both in terms of the policy implications and the politics.”

The Washington Post’s Kelsey Snell and Sean Sullivan contributed to this report.

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