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Republicans Divided on Health Care Look to Trump for Guidance

A significant number of House Republicans have come out strongly against leaked draft legislation to repeal and replace the Affordable Care Act.
IMAGES: Rep. Mark Meadows
Rep. Mark Meadows, R-North Carolina, was one of 25 House conservatives to vote against Rep. John Boehner's re-election as speaker in January.AP

As President Donald Trump prepares to give his first national address Tuesday night, a divided Republican Congress looks to the White House for guidance on what the party should do about health care.

After Rep. Mark Walker, a key House Republican, announced his opposition to leaked draft legislation to repeal and replace the Affordable Care Act Monday, other lawmakers have followed suit, coming out strongly against the current plan. Opponents say there's enough opposition to the proposed bill to prevent its passage with just Republican votes.

Asked if he could support the draft bill in its current form, Rep. Mark Meadows, chair of the House Freedom Caucus, a group of about 40 tea-party minded members, said, “I cannot.”

Why? “I can give you three of four different reasons,” Meadows said.

When Rep. Dave Brat, R-Virginia, was asked if he could support it, he said, “No. No, no, no, no.”

There is little in the draft bill that these conservative members find appealing.

“We didn’t tell the voters we were going to repeal Obamacare but keep the Medicaid expansion. We didn’t tell the voters we were going to repeal Obamacare and then keep some tax increases. We didn’t tell the voters we were going to repeal Obamacare and start a whole new entitlement,” Rep. Jim Jordan, R-Ohio, and former chair of the Freedom Caucus, said. “Real simple: we should do what we said.”

Even some senators are expressing concern, including Sen. Rand Paul, R-Kentucky, who has advocated that his own health care proposal be the one considered for passage.

The 105-page draft proposal dated February 10 was leaked last week and obtained by NBC News after circulating among health care lobbyists. While changes are possible, it is believed to be a legitimate effort at health care reform.

According to Meadows, there are "a lot more than 22" GOP members of the House who are opposed to the draft legislation, signaling that House leadership won't have the votes to pass it in its current form.

The flood of Republican opposition to the bill as written underscores the challenges House Republicans face in dismantling the Affordable Care Act and passing a replacement.

Related: GOP Draft Health Care Bill Cuts Medicaid, Insurance Subsidies

Members of the party are divided on what a replacement should look like and how much it should cost. Republican leaders, meanwhile, have promised not to "pull the rug" out from under people who are covered by current law after facing scores of angry voters at town halls across the country, and Trump promised repeatedly on the campaign trail not to cut entitlements like Medicaid. The party must square all that with conservatives who are wary of government spending for health care.

House Speaker Paul Ryan implied that conservatives are moving the goal posts.

“The Price Plan was considered the conservative gold standard at the time last year,” Ryan said of the previous plan proposed by former Rep. Tom Price, now Trump's Health and Human Services Secretary. “Many conservatives co-sponsored that plan. That plan looks a lot like what we're working on right now.”

At their weekly meeting of Republican House members Tuesday morning, members said there was little time left for questions on health care. Some Republicans have claimed that House leadership is not collaborating with rank-and-file on the process of crafting the bill.

“They’ve asked for everybody’s input,” Meadows said. “Obviously the final result of where we are today is not something that I support and I’m not alone in that analysis.”

But leadership aides said that House Republican Whip Steve Scalise holds listening sessions with members, and that Thursday’s planning meeting featuring Gov. Scott Walker, R-Wisc., will focus on health care.

House leadership noted that the bill is a draft and that changes have already been made.

However, AshLee Strong, a spokeswoman to House Speaker Paul Ryan, said that the draft proposal contains the main elements, including tax credits for people purchasing health insurance based on age.

Ryan insisted that Republicans will get on board in the end.

“I feel at the end of the day, when we get everything done and right, we're going to be unified on this," Ryan said.

The draft bill phases out the current Medicaid expansion and would implement grants for states to provide Medicaid based on population, instead of on a person's income.

It gets rid of the subsidies for health insurance based on income and replaces it with tax cuts based on age. The proposal also creates state-based high risk pools for people with pre-existing conditions or are expensive to insure, and it greatly expands the use of Health Savings Accounts.

Additionally, as Republicans struggle to figure out a way to pay for their ACA replacement, the proposed bill calls for a tax on the most expensive employer-based health insurance plans, which is an expanded version of the so-called Cadillac tax on the most expensive employer based plans.

Republican governors have offered input, especially those who come from states that expanded Medicaid under the ACA.

Gov. Brian Sandoval, R-Nevada, expressed concern with the Republican plan to provide Medicaid funding to states based on per capita. Following a meeting with the nation’s governors, he said he wants to see the funding formula to ensure that he’s able to provide Medicaid for the people who need it without an extra burden placed on the state budget.

As for Trump, he has been mum on the details of a replacement plan. Members are looking to him to provide some guidance in his speech tonight.

“I hope (Trump) doesn’t buy on to this plan because he will be ill-served,” said Brat of the draft plan. “Coming in as a Republican president is a net tax increase and a federal new entitlement program. That’s your first big move? And then you gotta do tax reform after that? Good luck.”