The biggest threats to the Republicans’ long-sought bid to replace Obamacare are Republicans. Leading the charge to charge to derail House Speaker Paul Ryan’s and Senate Majority Leader Mitch McConnell’s health care plan is not a Democrat, but McConnell’s fellow Kentucky Republican, Sen. Rand Paul.
Paul is firmly allied with members of the conservative House Freedom Caucus in a dogged effort to defeat the GOP leadership’s American Health Care Act.
Paul has been on a mission since this Congress convened in January to make sure the leaders’ effort implodes.
For weeks, he’s criticized the secret process of negotiating the replacement bill, calling it “Obamacare lite.” In January, he was the only Senate Republican to vote against the first step in repealing the law.
Last week, Paul demanded to see a copy of the bill and even took his own copy machine to the room in the House of Representatives side of the Capitol where the draft was locked down. Surrounded by a gaggle of reporters and cameras, he was turned away.
Though Ryan insisted Tuesday that he’d be able to get the 218 votes he needed to pass the bill in the House and McConnell optimistically predicted Senate passage, Paul’s army made clear that the bill didn’t go far enough to scale back former President Barack Obama’s signature Affordable Care Act.
Instead, Paul said lawmakers should first vote on the same repeal bill that passed Congress but was vetoed last year by Obama, then vote on competing replacement proposals from the Republican leadership and conservatives.
“We are united on repeal, but we are divided on replacement,” Paul said. “What’s the best way to get past this impasse? Let’s vote on what we voted on before: a clean repeal.”
If Paul’s coalition holds, it could doom the leadership’s replacement bill in both chambers.
Ryan can afford to lose only 19 Republicans, since no Democrats are likely to vote for the bill. With Utah Republican Sen. Mike Lee joining Paul’s chorus, McConnell can afford to lose only one more Republican vote from his narrow 52-member majority.
The Freedom Caucus consists of some three dozen of the most conservative House members. Several of them indicated after a meeting with Vice President Mike Pence that the initial bill wasn’t acceptable.
“We have some serious concerns,” said Rep. Mark Meadows, R-N.C., the group’s chairman.
Paul and Sen. Ted Cruz, R-Texas, have pushed their own alternative health care replacement bills that would go much further in undoing Obamacare than what House leaders have proposed.
Conservatives want to unravel the Affordable Care Act’s expansion of Medicaid, the state-federal health insurance program for low-income and disabled Americans. The Republican leadership’s bill would keep the Medicaid expansion intact through 2020.
Medicaid now covers 30 percent of the population of Paul’s home state. Under the Affordable Care Act, Kentucky’s uninsured rate dropped from 15 percent to 6 percent.
Paul’s bill would make it easier for states to experiment with their own Medicaid blueprints. Kentucky Republican Gov. Matt Bevin has requested a waiver from the federal government to change the state’s program to shift more of the cost to recipients.
Conservatives also don’t like the replacement bill’s tax credits to help people buy insurance. To them, it’s too similar to the subsidies the current law offers.
But Republican leaders seem confident that they’ll get the votes they need for their American Health Care Act.
“This is the conservative alternative to Obamacare,” said Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee.
McConnell said Republican leaders would be open to improvements and recommendations from members as the bill moves forward.
“In the weeks ahead, we are very confident that the American Health Care Act, with their help, will be on the president’s desk and we will start over with a new future for health care in America,” McConnell said.
But Paul said House and Senate conservatives, if they stuck together, had the power to withhold their support for the bill to force the changes they wanted.
“If they have 218 votes, there won’t be any change. That will be the bill,” Paul said Tuesday. “If they don’t have 218 votes, there will be a negotiation, and conservatives will have a seat at the table.”