In an interview with Fox News Sunday, House Speaker Paul Ryan said that Republicans were looking to make some small changes to their healthcare bill before it comes up for a floor vote later this week.
“I think Thursday is most likely the day to bring it forward,” Ryan said when asked about a timetable on a full House vote. “We are still having conversations with our members. We are making fine-tuning improvements to the bill to reflect people’s concerns, to reflect people’s improvements.”
Ryan said he was confident about having enough votes to push the bill through to the Senate, and he praised President Trump for his efforts in persuading skeptical Republicans on Capitol Hill.
“I’m very impressed with how the president is helping us close this bill,” Ryan said. “The president has become a great closer. He’s the one who has helped negotiate the changes in this bill with members from all over our caucus.”
Those changes reportedly include a special amendment to allow states to insert a work requirement clause into Medicaid. Conservatives were incensed when Obama expanded Medicaid beyond its intended base, ultimately allowing more than 11 million able-bodied, single, childless adults onto the system. To make matters worse, Obama consistently rejected any state requests to impose a work requirement on the healthcare program. Since many states will opt for block grant funding under the new American Health Care Act, conservative Republicans say it’s more important than ever to give those states some flexibility when it comes to accepting customers.
The other change – this one implemented to appease another faction of House Republicans – is an adjustment to how tax credits will be awarded to older Americans. An early argument in favor of the GOP healthcare bill was that it treated all insurance-purchasers the same as far as tax credits were concerned, but some lawmakers were alarmed by how this system would affect people in their 50s and 60s who purchase plans off the individual market. It’s not yet clear how Ryan and Trump intend to address this problem before the vote.
The 40-member Freedom Caucus in the House is still publicly resisting the bill, angry that it keeps so much of the Obamacare structure in place. If they vote in a wave, the bill will die a quick death on the House floor. But if Ryan can get at least half of them on board (and the Republican moderates), he’ll have the AHCA in Mitch McConnell’s inbox by the end of the week.
And then the real battle will begin.