The Republican health care bill passed another step of the process Thursday morning as the House Budget Committee advanced the measure out of its committee despite growing opposition from Republicans.
The bill's advancement was another victory for House Speaker Paul Ryan who had a heavy hand in writing the legislation but has had to face vocal opposition from some corners of his Republican conference who say it enshrines Medicaid and creates a new entitlement program.
Three Republicans, all members of the conservative Freedom Caucus, voted with all Democrats against he measure: Reps. Dave Brat of Virginia, Gary Palmer of Alabama, and Mark Sanford of South Carolina. But because of the large number of Republicans on the committee, the measure still passed 19 to 17.
Due to the concentration of conservative members on the Budget Committee, the vote was a critical step in the process where Republicans had an opportunity to kill the measure, but most of them stayed in line and voted in favor for the bill.
Because of House rules, the committee was unable to make changes to the bill despite concerns from Republicans who say they won't support it on the House floor in its current form.
After earlier insisting that the bill will move forward with no changes, House Speaker Paul Ryan indicated Wednesday that he's open to amending the measure after a report by the Congressional Budget Office reported that 24 million people could lose health insurance under the Republican plan in the next decade.
"Now that we have the score, we can incorporate feedback to improve this bill, to refine this bill and those kinds of conversations are occurring between the White House, the House and the Senate and our members," Ryan told reporters Wednesday evening.
Rep. Brat, who has been a vocal opponent to the health care bill, said that the current bill is "not anywhere near passage." He said that the White House is discussing concessions to help get him and his conservative colleagues on board.
Several conservatives say House Speaker Paul Ryan has not reached out to him to discuss changes to the bill.
"I've found President Trump to be much more accommodating than our leadership has been," said Rep. Louis Gohmert, R-Texas.
Gohmert and other conservative members of the Freedom Caucus are crafting an amendment to present to the leadership of the changes they want. While they wouldn't detail the contents yet, it is expected to address many of their concerns.
Brat said regulations placed on insurance plans must be rolled back and work requirements for Medicaid recipients must be imposed to propel conservatives on board.
Only then would "a lot of people get to yes," Brat said.
The insurance regulations that are held over from the Affordable Care Act include the essential benefits package, which are the required benefits insurance plans must provide for consumers, including maternity care. Another insurance regulation that conservatives don't like is that insurance companies can charge older people five times more than younger consumers. Conservatives want that cap lifted. (The ACA only allows health insurance companies charge older people three times as much as younger people.)
But it's not just conservative Republicans who are opposed. The moderates in the party are, too. They are concerned that the bill will kick too many people off of Medicaid and the tax credits to help people purchase insurance in the individual market won't be enough to help people purchase insurance, especially in states where the cost of insurance is disproportionately high..
"There's no natural constituency for this bill," he said at a monthly meeting called "conversations with conservatives" where conservative members spend an house taking questions from the press. "The left is really mad about it; the right is really made about it; the middle is really mad about it."
Brat says leadership can't appease both groups.
"You can't do that," Brat said. "The moderates and people in tough seats always want to offer more stuff."
The next step is the Rules Committee where the bill could be changed. Then it would go to the House floor, giving all members the opportunity to vote for — or against — the measure.
Republican leadership had hoped to pass the bill next Thursday, which also happens to be the seventh anniversary of the passage of the Affordable Care Act.