Republican leaders warn that changing health care bill would doom it in Senate

WASHINGTON — House Republican leaders warned their members Thursday that any major changes to the proposed GOP health care bill will prevent its passage in the Senate and kill their best shot at ending Obamacare.

Those warnings came as both the House Ways and Means Committee and the Energy and Commerce Committee approved the GOP's American Health Care Act on Thursday without significant amendments after marathon debates.

"This is the closest we will ever get to repealing and replacing Obamacare," House Speaker Paul Ryan, R-Wis., said at a news conference Thursday that focused on trying to quell conservative critics' concerns about the legislation. "The time is here. The time is now. This is the moment."

The Republican bill to repeal and replace former President Obama's Affordable Care Act is carefully designed to meet budget restrictions to ensure that it can pass without the need for any Democratic support in the closely divided Senate. The kind of big changes that some conservative lawmakers and interest groups are calling for would violate those budget restrictions and allow Democrats to block the bill in the Senate, Ryan said.

"You can't put everything you want in that legislation because it would be filibustered and you couldn't even bring it up for a vote in the Senate," Ryan told reporters in a 35-minute briefing that came complete with a PowerPoint presentation detailing the GOP strategy.

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He said there has been "a lot of frustration and confusion out there" among conservatives about what can and cannot be included in a bill that can be pushed through the Senate without Democratic support.

"What people are learning is this (budget) reconciliation bill is pretty tight," Ryan said. "There are a lot of things we don't put in this bill."

Ryan, along with House Majority Leader Kevin McCarthy, R-Calif., and Majority Whip Steve Scalise, R-La., were hammering that point home Thursday on TV and radio appearances aimed at reaching conservatives.

"If you want to see Obamacare replaced, this is the best opportunity to do it," McCarthy said on Fox and Friends.

The message was a bit different from what President Trump has been suggesting. He told a group of conservatives Wednesday night that there may still be room to renegotiate key elements of the bill.

So far, House leaders and committee chairmen have managed to discourage any major changes in the bill, which still must be approved by the House Budget Committee and then sent to the Rules Committee. Ryan said the bill, which was unveiled Monday night, would go through two more weeks of committee process before heading to the House floor for a vote in late March.

The Energy and Commerce Committee rejected amendments that would have frozen new enrollment in Obamacare’s expanded Medicaid expansion at the end of 2017 instead of 2020 and created work requirements for able-bodied, childless adults to receive Medicaid benefits. Those changes were supported by the Republican Study Committee, a group of more than 150 House conservatives. However, the changes would likely have faced opposition from some moderate Republicans in the Senate whose states expanded Medicaid under Obamacare.

Despite their success in the two key committees on Thursday, House leaders still face opposition to the bill from within the GOP.

Sen. Tom Cotton, R-Ark., wrote a series of tweets on Thursday declaring that the House should "start over" on the legislation and quit trying to to rush it through the way Democrats rushed through Obamacare.

"House health-care bill can't pass Senate without major changes," the conservative senator wrote on Twitter. "To my friends in House: pause, start over. Get it right, don't get it fast."

Cotton and Senate Majority Leader Mitch McConnell, R-Ky., also said Thursday they want to see an estimate from the non-partisan Congressional Budget Office of how much the bill is going to cost. Democrats have been pressing for that estimate, and Ryan has promised that the House will not vote on the bill until the CBO report is out. Ryan said Thursday that Republicans may have to "tweak" the bill a bit once those figures are released.

Ryan said the budget process that Republicans are using to speed the legislation through Congress has "certain limits" that preclude some provisions he and other GOP members would like to see, including allowing people to buy insurance across state lines. However, he said the bill will be followed by separate legislation to address that issue and others. The problem with that separate legislation, Ryan acknowledged, is that it will require 60 votes in the Senate to pass, and Republicans hold just 52 seats.

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Health and Human Services Secretary Tom Price will be able to use his administrative powers to "do a lot through deregulation" of the insurance market, Ryan added.

He said that sitting back and letting Obamacare fail and blaming Democrats would hurt too many people by driving up their insurance costs and driving insurers out of the market.

"We can fix this problem," Ryan said. "We promised the American people we would fix this problem."

Senate Minority Leader Chuck Schumer, D-N.Y., said Republicans are scrambling to keep their own members in line because the bill is "one big mess."

"This bill is one big mess, done quickly in the dark of night," Schumer said Thursday. "It’s no wonder Leader McConnell and Speaker Ryan don’t want a lot of debate. They’re embarrassed. This bill is an embarrassment to those who put it in, because it doesn’t do what it’s supposed to do."