Republicans powered their Obamacare repeal-and-replace plan through two committees Thursday, maintaining unity — at least for now — as President Trump rebuked naysayers and said the ugly health care debate will end with a “beautiful picture.”
The House Energy and Commerce Committee approved its half of the plan after 27 hours of debate in which Democrats used procedural tricks to stall debate and made ill-fated attempts to preserve key parts of Obamacare. Republicans swatted away their amendments, leaving the Republican effort intact after the House tax-writing committee cleared its piece of the puzzle.
“We’re delivering for President Trump on his health care plan,” said House Ways and Means Committee Chairman Kevin Brady, Texas Republican.
The House Budget Committee plans to meet Wednesday to begin fusing the twin bills into legislation that uses arcane budget rules to avoid a Democratic filibuster in the Senate, assuming it gets there.
A number of House conservatives have complained that the plan creates another entitlement and “individual mandate” through insurers while allowing states that expanded Medicaid to tap federal coffers for too long, so significant changes might be needed to win their support.
Leaders can go only so far, however, before scaring off Republican centrists who are wary of unwinding benefits that took root under the Affordable Care Act.
Mr. Trump, the negotiator in chief, said it will all work out.
“Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!” he said on Twitter.
Mr. Trump and Republican leaders cannot afford to lose more than 21 Republican votes in the House or more than two in the Senate. They won’t get any help from Democrats, who say the plan will force poorer Americans to pay more for skimpier coverage.
House Speaker Paul D. Ryan, Wisconsin Republican, rolled up his sleeves and pitched the plan to reporters, TED Talk-style, in a bid to earn better coverage of an effort that has been panned by hospital associations and influential groups such as the AARP for seniors and the free market Club for Growth.
The plan replaces Obamacare’s income-based subsidies with age-based, refundable tax credits for people who buy insurance on their own, while gradually unwinding President Obama’s expansion of Medicaid, the government insurance program for the poor.
The Republican Study Committee, a bloc of roughly 170 conservatives, said it formally supported a proposal by Rep. Joe Barton, Texas Republican, to freeze Medicaid enrollment under Obamacare’s generous funding rates at the end of this year rather than letting states herd more people into their expanded programs until 2020.
It also endorsed a proposal by Rep. H. Morgan Griffith, Virginia Republican, to institute work requirements for able-bodied, childless adults on Medicaid.
“While I continue to have concerns about this bill, the adoption of these amendments would be a critical step in the right direction,” said Rep. Mark Walker, North Carolina Republican and RSC chairman.
Though the White House and party leaders said they were open to tweaks, Mr. Ryan pushed against conservatives who say they will refuse to back a bill that falls short of everything they want.
“This is the closest we will ever get to repealing and replacing Obamacare. The time is here. The time is now,” he said. “This is the moment, and this is the closest this will ever happen. It really comes down to a binary choice.”
He promised that those with pre-existing conditions won’t lose their coverage, and young people will still be allowed to stay on their parents’ plans until age 26 — both popular parts of Obamacare. But he said Medicaid must be reeled in and returned to the states so they can figure out better ways to manage the program and control its costs.
He said drafters had to stick to tight rules on the first piece of a three-pronged plan to meet strict budget rules on the Senate side but that other ideas, such as letting insurers sell their plans across state lines, can be part of the future bills.
House Minority Leader Nancy Pelosi, California Democrat, rejected the Republicans’ opening bid, saying there wasn’t anything redeeming in it. She said it violated every goal of Obamacare: lower costs, better benefits and expanded numbers of people covered.
Mrs. Pelosi said it would be Mr. Trump’s voters who suffer under the Republican bill and called it a massive “transfer of wealth” from red states to blue states. She said poor Republicans would lose coverage while rich people in Democratic states would receive tax cuts with the repeal of Obamacare.
“Sadly, the people who will lose care if the Republican plan were to prevail, which I doubt it will, are people who voted for Donald Trump, many of them,” she said.
Sen. Tom Cotton, an Arkansas Republican whose red state leveraged Obamacare dollars to help an influx of would-be Medicaid enrollees buy private plans instead, emerged as a vocal critic of the House effort, saying the votes didn’t add up on his side of the Capitol.
“House health care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast,” he said on Twitter, chastising the House for racing ahead without Congressional Budget Office estimates on the plan’s economic effects and how many people would be covered.
The Trump administration said it would like to hear the senator’s ideas for reform.
“We’re not jamming this down people’s throat,” White House press secretary Sean Spicer said.
“Sen. Cotton clearly recognizes that the current version of health care that is out there right now is not sustainable. We continue to welcome his input on this. We’re going to let the process work its will,” Mr. Spicer said.
Mr. Trump and Vice President Mike Pence plan to travel around the country in states with wavering lawmakers to push for passage of the House plan.
The president also met with conservative leaders at the White House on Wednesday night and persuaded them to at least hold their fire against the legislation, which some critics have dubbed “Trumpcare” or “Ryancare.”
“I don’t care what it’s called,” Mr. Brady said. “I just want to give Americans affordable health care that they choose, not Washington.”
• Dave Boyer and Stephen Dinan contributed to this report.