It took seven years to write, but House Republicans’ Obamacare replacement plan began to unwind Tuesday after less than a day in the public eye.
Conservatives said the proposal Republican leaders have offered amounts to “Obamacare lite” and vowed to rally opposition from the right. Meanwhile, moderate Republicans complained that it went too far in unraveling the Affordable Care Act’s benefits, such as expanded coverage for the poor under Medicaid.
The White House, meanwhile, called it a first step and insisted that later phases would contain more of President Trump’s campaign promises such as selling insurance across state lines.
Republican leaders in Congress held firm, however, insisting that they will be able to cobble together enough votes to pass the repeal through the House, where it will get its first test.
“We will have 218 votes,” said House Speaker Paul D. Ryan, Wisconsin Republican, referring to the number needed to pass the chamber.
He and fellow Republican leaders revealed their plans Monday night and have scheduled the first committee votes for Wednesday.
SEE ALSO: Paul Ryan, Kevin McCarthy Obamacare replacement should be called ‘Abominable Care’
But what should have been a triumphant moment, after seven years of struggling to write a replacement bill, instead turned into a day of putting out fires.
Mr. Trump and Vice President Mike Pence portrayed the plan as an opening bid that is up for negotiation — though they said the bill will be the Republicans’ best chance for repeal.
“Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!” the president tweeted.
House and Senate conservatives were accepting Mr. Trump’s invitation to negotiate.
They said the refundable, age-based tax credits designed to replace Obamacare’s exchanges amount to a Republican-authored entitlement program. They said that having insurers tack a 30 percent surcharge on new customers who failed to maintain coverage — a way to make sure customers don’t wait until they are sick to buy coverage — is no better than Obamacare’s loathed individual mandate.
The Republican plan unwinds Obamacare’s vast expansion of Medicaid but does so only gradually after 2020. It is an effort to satisfy Republican governors in 31 states that have signed up for the expansion.
SEE ALSO: Most think Donald Trump, GOP will repeal Obamacare, pass tax reform: Poll
“This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction,” said Sen. Mike Lee, Utah Republican.
Republican leaders are relying on fast-track budget rules to try to avoid a filibuster by Democrats in the Senate, but they still will need near-unanimity within their own troops.
They cannot afford to lose more than 21 Republican votes in the House or more than two in the Senate because they won’t get any help from Democrats, who jeered the plan as a “reverse Robin Hood” that slashes benefits from the poor to cut taxes for high earners and health care companies.
“They’re ashamed of this plan, and it’s amazing to me that after eight years they are so ill-prepared that they don’t have their act together and that both from the right side of their party and the left side of their party, people are taking shots at it,” said Sen. Charles E. Schumer, New York Democrat.
House Minority Leader Nancy Pelosi, California Democrat, chastised Republicans for forcing votes without knowing more about the bill’s impact on the economy or its “score” — the legislation’s anticipated effect on the federal budget as calculated by the Congressional Budget Office.
How the plan stacks up against Obamacare is key to the fight, and for years Democrats have listened to Republican lawmakers taunt the 2010 law as a mammoth backroom deal that no one actually read.
An analysis by the nonpartisan Kaiser Family Foundation said Republican tax credits would be at least a third less generous than Obamacare’s subsidies, on average, and tend to benefit people with higher incomes.
The AARP, an influential group that lobbies for seniors, said it opposes the bill, in part because it would let insurers charge older persons five times what it charges younger consumers. Right now, Obamacare mandates a three-to-one ratio.
“This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits,” AARP Vice President Joyce A. Rogers said in a letter to congressional leaders.
Repealing a slew of Obamacare taxes will punch a budget hole of nearly $600 billion through 2026, according to the Joint Committee on Taxation. The most notable savings come from eliminating a 3.8 percent tax on investment income for wealthier individuals and families, at $158 billion over the decadelong budget window.
Republican committee chairmen said the bill represents their party’s chance to make good on campaign promises.
“As Republicans, we have a choice: We can act now or we can keep fiddling around and squander this opportunity to repeal Obamacare, and begin a new chapter of freedom for the American people,” said House Ways and Means Committee Chairman Kevin Brady, Texas Republican. “House Republicans are choosing to act now.”
Mr. Brady said those who see the plan as “Obamacare lite” should instead view is as “Obamacare gone.”
But Sen. Rand Paul, Kentucky Republican, and Rep. Jim Jordan, Ohio Republican, said leaders should shelve the plan and revive a 2015 repeal effort that would have gutted Obamacare and drew widespread support before meeting President Obama’s veto.
“How about using the bill we all supported?” said Mr. Jordan, a prominent member of the House Freedom Caucus, a group of about 40 Republicans who frequently clash with the party’s leadership.
At the White House, press secretary Sean Spicer said Mr. Trump is “absolutely committed” to the House plan, dubbed the American Health Care Act.
Mr. Trump singled out Mr. Paul on Twitter late Tuesday, saying he was sure the Kentuckian would “come along with the new and great health care program because he knows Obamacare is a disaster!”
The American Action Network, a group that is allied with Mr. Ryan, said it will run ads promoting the House plan in 21 congressional districts held by Republicans. Those include lawmakers on key committees and vocal critics such as Mr. Jordan and Freedom Caucus Chairman Mark Meadows of North Carolina.
Still, a slew of conservative groups — Heritage Action, the Club for Growth and two groups funded in part by the influential Koch brothers, Americans for Prosperity and Freedom Partners — exerted pressure from the other side, saying the plan falls short of the Republicans’ promise to usher in conservative, free-market principles.
FreedomWorks promised a six-figure ad buy, saying its activists are “furious at this betrayal.”
“I don’t think anyone is going to be happy. It is just a question whether House leadership can muscle it through,” said Timothy Jost, a law professor at Washington and Lee University who tracks the health care debate. “Trump may be helpful, but he certainly will be no help with Democrats and probably doesn’t pull too much weight with the extreme conservatives.”