Republicans vowed for years to repeal and replace the Affordable Care Act — but as the House prepares to vote on its replacement Thursday, a faction of the party is standing in the way.
The House Freedom Caucus, a group of about three dozen “ultra-conservative” Republican lawmakers in the lower chamber, said Thursday that its members had failed to strike a deal with Republican leadership to support the American Health Care Act, despite meeting with President Donald Trump to try to find a compromise.
The group is concerned that the American Health Care Act still retains too many of that law’s mandates and that, without further scaling them back, health insurance premiums will remain too high for them to support the legislation. Despite their majority in the House, Republicans can only afford 22 defecting votes for the bill to proceed to the Senate — and the caucus’s about 40 members, some of whom remain secret, could stop its passage.
The Freedom Caucus was created by nine hard-line conservatives in January 2015 as a splinter group to advance more conservative interests in the House. It has repeatedly pushed back against more establishment Republicans, using its leverage to push former Speaker John Boehner to resign in 2015 and halt Majority Leader Kevin McCarthy’s run to replace him.
But the Freedom Caucus’ votes are particularly powerful in the health care fight because moderate Republicans like Sens. Lisa Murkowski of Alaska and Susan Collins of Maine have also objected to certain portions of the repeal-and-replace plan. In response, Republican leaders tried to convince the Freedom Caucus to relax its demands, pointing to limitations on the legislative process of reconciliation that they are using to push the legislation through with a simple majority, the Washington Post reported.
Ryan and other leaders had argued that adding the rollbacks the Freedom Caucus wants would make the bill ineligible for the reconciliation process and preclude passage without Democratic votes. Congressional Republicans were also eager to finally repeal the Affordable Care Act, which they have sought to do since its passage in 2010. President Donald Trump made repealing and replacing former President Barack Obama’s signature health law one of his core promises on the campaign trail.
Trump and Ryan had spent weeks trying to convince Republicans to support the bill in meetings and promised to address some of those concerns through amendments and new provisions should the bill make it to the Senate. Trump met with members of the caucus Wednesday, after which a spokesman for caucus chairman U.S. Rep. Mark Meadows, R-N.C., said the group was “cautiously optimistic,” according to NBC News.
But another meeting Thursday among members of the caucus and the president ended with no deal to secure all of the caucus’ votes, possibly throwing the future of the Republican health care bill into doubt.