The Obamacare replacement bill could die on Thursday

The much-maligned Obamacare replacement bill will face its biggest test so far on Thursday, as a House of Representatives committee filled with conservatives could derail the legislation backed by Speaker Paul Ryan before it gets to the House floor.

If four Republicans join Democrats in voting against the bill in the House Budget Committee, the legislation will fail.

The uncertainty comes as the nonpartisan Congressional Budget Office released its estimate on the bill. It predicted Monday that 24 million people would lose health coverage by 2026 but that there would be a cut to the federal budget deficit of $337 billion over the first decade.

At least seven Republican members of the Budget Committee have made public statements in the past week indicating they want a full repeal of Obamacare, but it’s unclear whether four of them will decide to go out on a limb and vote no.

One of them, Mark Sanford of South Carolina, joined Kentucky Sen. Rand Paul at a news conference last week to slam the legislation as a dereliction of the Republican Party’s campaign promises.

“Inasmuch as President Trump views many things as a negotiation, I’m quite sure he would rarely take any party’s opening bid,” Sanford said then.

“The debate that is forming will allow conservatives to enhance and improve what has been proposed,” he said, “and I think this could represent a win for patients, health care providers and the taxpayer alike.”

Expressing concern is one thing, but a no vote by any GOP member in committee is another – a calculated risk for rank-and-file Republicans.

A no vote would anger Republican leadership and potentially make it harder to overturn even portions of Obamacare, while a yes vote does not ensure that the final bill on the House floor will appeal to conservatives who want a full repeal.

Unlike last week, when the bill made it through both the Energy and Commerce and the Ways and Means committees with little Republican opposition, members of the ultra-conservative Freedom Caucus and other conservative lawmakers who sit on the Budget Committee will have their chance to make a political statement.

Three members of the Budget Committee – Sanford, Dave Brat of Virginia and Gary Palmer of Alabama – are members of the Freedom Caucus, a group of lawmakers who have voiced concerns about the legislation. Brat has gone one step further, indicating he will vote against the bill as written.

If those three lawmakers choose to vote no, only one other Republican “no” is needed to kill the bill, and there’s a host of options.

Florida freshman Rep. Matt Gaetz was a vocal opponent of Obamacare on the campaign trail and said, “I come to bury Obamacare,” in one of his first speeches in Congress.

Rep. Tom McClintock of California, a former Freedom Caucus member, said he was “looking at it” when asked last week whether he supports the bill.

Rep. Glenn Grothman of Wisconsin is concerned with how many employers would provide coverage under the Republican-sponsored plan.

“As drafted, the current replacement plan could result in even less people on employer plans than under Obamacare – with the credits possibly creating an incentive for employers to drop coverage,” Grothman said in a statement.

The Budget Committee is a largely procedural body, and it will not consider amendments to the bill.

Chairman Diane Black of Tennessee will hear about a half-dozen procedural motions during the hearing Thursday before moving to vote on the legislation, where conservative rank-and-file Republicans will have their shot to steal the national spotlight.

This post was updated after the Budget Committee announced the hearing was moved from Wednesday to Thursday to accommodate for inclement weather.

Alex Daugherty: 202-383-6049, @alextdaugherty

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