The long-promised GOP bill to repeal and replace Obamacare is facing opposition from all sides, and a constellation of conservative and moderate Republicans have attacked the legislation, even though it has the support of President Donald Trump,
Democrats, of course, are unified in their opposition.
The bill is being debated in the House of Representatives, where it will move through four committees before a vote proceeds on the House floor. Republican leaders want to vote on the legislation on March 23, the day Obamacare was signed into law in 2010, but they don’t have much room for error. Republicans can afford to lose 21 votes in the House and pass the bill with a simple majority of 216 votes.
Though the bill could undergo significant changes in the coming weeks, the slim Republican majority in the Senate means just a few defections could sink or severely delay its potential passage. Here is a list of all the players opposed in some form to the legislation, passage of which would fulfill the GOP’s biggest campaign pledge, and what they can do to change or stop it.
Conservative House Republicans
Conservative Republicans in the House, including a group dubbed the Freedom Caucus that’s led by Mark Meadows of North Carolina, worry that the bill does not fully repeal Obamacare. Members say portions of the legislation would create a new federal entitlement, akin to Medicare, that would cost billions and add to the national debt.
Some conservative members have vowed to vote against the bill in its current form and have offered an alternative plan that fully repeals Obamacare without a replacement. Conservative members could be persuaded to vote for the legislation if they are assured it will not significantly increase federal spending.
Moderate House Republicans
Moderate Republicans, many who represent districts with constituents dependent on Obamacare, are worried that the current legislation will force people in their districts to lose health insurance. If that happens, they could be vulnerable during the 2018 elections.
If conservative Republicans get their way and more provisions of Obamacare are scaled back or repealed, then moderates will be less likely to support it. If moderates get their way, some conservatives will not vote for the bill.
Conservative Senate Republicans
Kentucky’s Rand Paul is leading an effort in the Senate to derail the proposal and replace it with a bill that fully repeals Obamacare, and he has Utah’s Mike Lee on his side. Texas’ Ted Cruz also wants to see major changes before voting in favor of the bill.
All three senators are closely aligned with a slew of conservative activist groups that have blasted the current Republican proposal as a watered-down version of Obamacare. The groups, including Heritage Action and FreedomWorks, are major supporters of the three senators. If the trio capitulates, Paul, Lee and Cruz run the risk of angering their conservative base.
The opposition of all three is significant because Republicans hold only a four-vote majority in the Senate. If all three vote against an Obamacare replacement proposal, it will fail.
Moderate Senate Republicans
Four Senate Republicans, Cory Gardner of Colorado, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio, vowed to vote against rolling back Medicaid expansion, a key portion of the bill for conservative members. Murkowski went one step further, vowing support for Planned Parenthood earlier this week. The women’s health organization, which also performs abortions, faces a significant reduction in funding under the current proposal.
A number of other senators, including Susan Collins of Maine and Marco Rubio of Florida, have also expressed concerns about the bill in its current form.
Again, if three Senate Republicans vote against the legislation, it will fail.
Outside medical interest groups
Every major hospital entity, along with America’s largest interest group, the AARP, is on the record opposing the bill. They are worried that rolling back Medicaid expansion could result in millions of Americans losing health coverage.
“We are very concerned that the draft legislative proposal being considered by the House committees could lead to tremendous instability for those seeking affordable coverage,” the medical groups said in a letter Wednesday to Congress. “Furthermore, we are deeply concerned that the proposed Medicaid program restructuring will result in both the loss of coverage for current enrollees as well as cuts to a program that provides health care services for our most vulnerable populations, including children, the elderly and disabled.”
Outside conservative interest groups
A number of influential conservative interest groups are vocally opposed to the plan, arguing that Americans deserve a full repeal of Obamacare. Heritage Action and FreedomWorks have begun rolling out ads blasting the Republican-sponsored measure. FreedomWorks has pledged to spend $250,000 to oppose the bill in the coming weeks, and the groups carry clout with conservative Republican voters and donors.
So who supports this bill?
House Republicans on the two committees that marked up the bill this week have been unified in their support, although no conservative Freedom Caucus members have had the opportunity to officially weigh in yet.
The committees are led by House Speaker Paul Ryan, R-Wis., who supports the legislation as part of his “better way” agenda. The U.S. Chamber of Commerce, an association of thousands of businesses across the country, also supports the bill.
Trump and his health and human services secretary, former Rep. Tom Price, support the legislation but are open to changes and suggestions from Congress.
Just a reminder: Senate Democrats were forced to broker multiple compromises within their own party in 2010 to pass the original version of Obamacare, and they had a much larger majority at the time than Senate Republicans currently enjoy, leaving Trump and Ryan little room for intraparty dissent.