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With just two days left before a vote on the GOP leadership’s bill to overhaul the US healthcare system, a battle is brewing between the conservative wing of the Republican Party and its leadership.
On Monday night, it became clear that many conservative Republicans in the House Freedom Caucus would not budge on their opposition to the bill, the American Health Care Act, leaving it vulnerable to losing the House vote.
Statements made by conservative leaders, however, leave a door open for House Speaker Paul Ryan and President Donald Trump’s administration to win over some of these representatives.
The question is whether GOP leaders have enough time to corral the members of their party.
Freedom Caucus pushback
The House Freedom Caucus has been against the AHCA since the release of the bill. The group has said it campaigned on a “full repeal” of Obamacare and the AHCA does not go far enough in dismantling the law, officially called the Affordable Care Act.
House Freedom Caucus Chairman Rep. Mark Meadows told reporters on Monday that his group was still opposed to the bill without substantial changes and that it would be “very difficult, if not impossible” for the GOP leaders to get enough votes for the bill without his caucus.
The group, however, has not taken an official position against the bill, meaning enough of its members have said they would vote in favor of it to prevent an official position.
Thus, the Trump team could in theory pick off members of the caucus, trying to win them over by promising more changes to the bill or additional measures in the future.
Despite this, Freedom Caucus members who are against the bill seem confident they can maintain the number of votes needed to block the bill if their demands are not met.
Rep. Justin Amash, who previously called the AHCA “Obamacare 2.0,” said on Twitter that even with a slew of changes released by the GOP leaders on Monday there still weren’t enough votes for it.
“They haven’t changed the bill’s general framework,” Amash tweeted. “They don’t have the votes to pass it. They have seriously miscalculated.”
Additionally, Rep. Raul Labrador told reporters the bill was “going to fail” without more changes to appease conservatives.
Some spoonfuls of sugar
In an attempt to win over some of the more conservative members of Congress, Republican leaders on Monday released a large amendment to edit the AHCA and provided some sweeteners to make the bill more palatable for the Freedom Caucus.
The new changes would move up the repeal of Obamacare’s taxes to 2017 from 2018, allow states to shift to block grant funding for Medicaid, and allow states to create work requirements for Medicaid beneficiaries. All of these changes appear to be targeted at conservatives to persuade them to vote for the AHCA.
Despite the amendment, House Freedom Caucus leaders, including Meadows, said on Monday that these changes were not enough to win over the group.
Thus, it appears that the GOP leadership must stick to old-fashioned vote wrangling to convert enough Freedom Caucus and conservative members to their side.
According to Politico, the Trump administration, rather than Ryan, has been doing the bulk of contact with conservatives. The reports suggest that administration officials such as Office of Management and Budget Director Mick Mulvaney (a former Freedom Caucus members) have been contacting members of the House to persuade them to get on board with the plan.
Trump has had a limited role in directly selling the bill, according to Politico, outside taking a meeting with the Republican Study Committee, another conservative group that was originally against the AHCA.
Despite the lack of intense salesmanship from Trump so far, the president is meeting with congressional Republicans on Tuesday to make one last pitch for the AHCA.
This sets up a furious race to the finish line as conservatives push for changes and Republican leaders try to go member by member to pick off enough votes to get to the 218 needed to pass the bill.
The House is expected to vote on the AHCA on Thursday.