As House leaders touted their replacement for the Affordable Care Act (ACA) Wednesday, many of their fellow Republicans remained unconvinced.
“This is a monumental, exciting conservative reform,” House Speaker Paul Ryan, R-Wis., said at a news conference. “I’ve been working on this for 20 years. This is exciting. This is what we’ve been dreaming about doing.”
President Donald Trump has also been promoting the legislation, which is intended to undo the 2010 law, often called Obamacare, and replace it with Republican policies. Trump met with House GOP whips Tuesday to discuss plans to get it through Congress.
“I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!” Trump tweeted on Tuesday night.
Sen. Paul is one of several prominent Republicans speaking out against the House bill, the American Health Care Act (AHCA), because they believe it does not go far enough in repealing Obamacare. However, a number of moderate Republicans fear that it goes too far and will leave more of their constituents without coverage.
With leadership pushing to pass the bill before the April recess, many questions remain about the bill, which was released on Monday. The Congressional Budget Office has not yet released official estimates of its cost and effects.
Rep. Matt Gaetz, R-Fla., is hesitant to lend support to the legislation until he has more information.
“I’m still reading and reviewing the legislation that’s been filed,” he said. “I know that’s sort of a novel concept in Washington, that you would read something and fully analyze its impacts before taking a position.”
Gaetz likes provisions in the bill that shift more control over health care to the states and provide disincentives to undocumented immigrants to enroll in welfare programs, but he wants some changes before it reaches the House floor for a vote.
“I think we can do even more to have bold reform for patient-centered health care,” he said.
The AHCA is a "good start," said Rep. Darin LaHood, R-Ill., but he added, "We have a long way to go."
Sen. John Boozman, R-Ark., called for diligence and patience in crafting a replacement for Obamacare.
“The changes that I would like to see is for us to slow down a little bit,” Boozman said in an interview Wednesday. “This is 18 percent of the economy. It affects all of us… It’s so, so very important that we get this right.”
The goal, he said, is to provide coverage for those who need it without ruining everyone else’s coverage. Senate Republicans are reviewing the AHCA now and will be watching closely for modifications that emerge from the mark-up sessions in the House Wednesday.
“There’s a number of people that are unhappy with the current product,” Boozman said. “That’s not really bad in the sense, you know, that’s how legislation is formed.”
He also recommended seeking feedback from hospitals, doctors, and governors to avoid unintended consequences.
Boozman also acknowledged the limitations of the budget reconciliation process Republicans are using to prevent a Democratic filibuster in the Senate. It enables them to pass a bill with a simple majority, but it can only be used for budget-related changes. Some policy reforms will have to come later.
“The thing that’s so important is lowering the cost curve, making things affordable,” he said.
With 52 Republican senators and no prospects for Democratic votes, there is little room for defections. Measures that roll back the ACA’s Medicaid expansion and withdraw federal funding from Planned Parenthood are already proving problematic with centrist GOP senators. Others, including Paul, complain about the costly tax credits that would replace the ACA’s subsidies.
Democrats have blasted the Republican proposal as a step backward for health care access that may ultimately cost more and cover fewer patients than the current system.
Rep. Jacky Rosen, D-Nev., said lawmakers would better serve the public by working in a bipartisan fashion to strengthen and amend the Affordable Care Act.
“I don’t support anything that’s going to hurt Nevada families,” she said.
Rosen and her fellow Democrats are studying the bill to determine the potential impact and cost of the programs Republicans are proposing.
“What I want everyone to know is this: behind every health care decision I’m going to make, I’m going to remember that there’s a mother, father, brother, sister, husband or wife,” she said.
Rep. Derek Kilmer, D-Wash., recalled the stories of numerous constituents whose lives were improved and possibly even saved by the changes made in the ACA.
"Health care policy isn’t just some ethereal conversation in marble buildings. It affects real people,” he said.
With Democrats firm in their opposition and some Republicans wavering, House leadership and President Trump are also facing blowback from their base.
"I did not protest for the past 8 years against Obamacare only to be delivered Obamacare-lite by Republicans," conservative talk radio host Dana Loesch said on Fox Business Wednesday.
Conservative think tanks and health care policy experts have been critical as well. Still, Trump adviser Kellyanne Conway guaranteed in an interview with Fox News that the American Health Care Act will pass.
“You’re either making good on the promise to repeal and replace Obamacare or you're not,” she said.