Tag Archives: Republicans

After weeks of secrecy, U.S. Senate to unveil healthcare bill

FILE PHOTO - U.S. President Donald Trump (C) acknowledges House Speaker Paul Ryan (3rdL) as he gathers with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By Susan Cornwell and Richard Cowan

WASHINGTON (Reuters) – U.S. Senate Republicans plan to unveil the text of their draft healthcare bill on Thursday as senators struggle over issues such as the future of the Medicaid program for the poor and bringing down insurance costs.

Republicans in the chamber have been working for weeks behind closed doors on legislation aimed at repealing and replacing major portions of the Affordable Care Act, former Democratic President Barack Obama’s signature healthcare law, popularly known as Obamacare.

The effort has been plagued from the start by tensions between moderates and conservatives, which surfaced again on Tuesday. Democrats have also criticized the behind-the-scenes meetings, staging a protest on the Senate floor on Monday.

“Republicans are writing their healthcare bill under the cover of darkness because they are ashamed of it,” Senate Democratic leader Chuck Schumer charged.

President Donald Trump campaigned on a promise to repeal Obamacare. The 2010 law extended insurance coverage to millions of Americans through both subsidized private insurance and an expansion of Medicaid.

The Republican-controlled House of Representatives narrowly approved its version of repeal last month.

Trump has urged the Republican-led Senate to pass a more “generous” bill than that approved by the House, whose version he privately called “mean,” according to congressional sources.

An estimated 23 million people could lose their healthcare under the House plan, according to the non-partisan Congressional Budget Office. Senate Majority Leader Mitch McConnell said on Tuesday the Senate healthcare bill would be different from the House version, but he did not elaborate.

In the Senate, moderates including Senator Shelley Moore Capito have argued for a long, seven-year phase-out to the Medicaid expansion that happened under Obamacare. But Senator John Thune, a member of the Republican leadership, said on Tuesday the phase-out in the bill might just be three years.

Capito said on Tuesday she was also concerned the Senate healthcare plan might cap Medicaid spending and shift it to a lower growth rate in 2025. “That’s an issue,” she said.

CONSERVATIVES WARY

Senate conservatives also seemed wary of the emerging bill. Ted Cruz, a member of a core group of 13 Republicans who have been working on the legislation, told reporters the bill did not yet do enough to lower health insurance premiums. “If it is going to pass, the bill is going to have to make meaningful steps to reduce premiums,” he said.

Given the opposition of all Senate Democrats to repealing Obamacare, Republican leaders will need the support of at least 50 of the chamber’s 52 Republicans to ensure passage.

McConnell announced a discussion draft would be laid out on Thursday. The bill will be brought to the Senate floor once the CBO has assessed its cost and impact, “likely next week,” McConnell said.

Thune said the bill was not yet finalized, saying: “We’re trying to get definitive determinations” on a range of issues.

Vice President Mike Pence predicted that new healthcare legislation would be enacted this summer.

“I want to assure you, before this summer is over … President Donald Trump and this Congress will keep their promise to the American people, and we will repeal and replace Obamacare,” Pence told a meeting of the National Association of Manufacturers.

(Editing by Caren Bohan and Peter Cooney)

Republicans still short of votes to pass U.S. healthcare overhaul

FILE PHOTO: A doctor checks the blood pressure of a patient in downtown Los Angeles, U.S., on July 30, 2007. REUTERS/Lucy Nicholson/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – Republicans in the U.S. House of Representatives said on Tuesday they were closer to agreeing on a reworked bill to overhaul the nation’s healthcare system but still lacked the votes to pass it, as President Donald Trump pressed lawmakers for a vote.

The White House has been pressuring House Republicans to push ahead with legislation to repeal and replace the Affordable Care Act, commonly called Obamacare, after a first effort failed in March in a major setback for the Trump administration.

“I think it’s time now” for a healthcare vote, Trump told lawmakers at the White House on Tuesday.

But Republican leaders, including House Speaker Paul Ryan, are once again struggling to balance the concerns of moderates, who want to protect Americans with pre-existing medical conditions, with the reluctance of conservatives to make changes.

Representative Mark Meadows of North Carolina, who heads the staunchly conservative House Freedom Caucus that helped block passage of the first bill, said Republicans were still “a handful of votes away.”

Representative Tom MacArthur of New Jersey, a Republican moderate who brokered a deal that revived the healthcare legislation, said there were still some moderates in the party sitting on the fence.

“It’s close. It’s close. We’re getting there,” MacArthur said.

Lawmakers are considering a bill that would allow states to opt out of Obamacare protections for people with pre-existing medical conditions – provisions that force insurers to charge sick people and healthy people the same rates.

That is seen as a concession to the Freedom Caucus, which has endorsed the new measure. In an interview earlier this week, Trump, however, insisted the new bill would maintain protections for those with pre-existing conditions.

Republicans have long vowed to repeal Democratic former President Barack Obama’s 2010 healthcare restructuring, arguing that the law, which allowed some 20 million Americans to gain healthcare insurance, was too intrusive and expensive.

During his 2016 campaign, Trump also vowed to get rid of it.

Republicans, however, remain divided over key provisions of the bill, with some lawmakers expressing worries of a spike in the number of people without coverage, or sharp increases in insurance premiums.

“They’re still talking about possible changes. If they don’t have the votes, then they’ll have to make changes,” Representative Peter King of New York, a Republican moderate, told reporters, indicating he would likely vote for the bill.

But any tack to the center to shore up moderates’ support threatens to spur defections on the Republican right flank.

“They change it one iota, I’m out,” Representative Dave Brat of Virginia, a Freedom Caucus member, told reporters.

OPPOSITION

Adding to the pressure on Republicans is the unified opposition of Democrats, many of whom view the 2010 healthcare law as the defining domestic achievement of Obama’s presidency, as do healthcare advocates.

Ten major patient advocacy groups, including the American Heart Association and American Diabetes Association, have said they opposed the reworked healthcare bill.

Other major medical groups such as the American Medical Association have also expressed concerns over coverage losses and unaffordable insurance for those with pre-existing conditions.

If a plan passes the House, it is expected to face a tough fight in the Senate, where Republicans have a narrower majority and where some party senators have expressed misgivings about the House bill.

(Reporting by Richard Cowan, David Morgan, Steve Holland and Doina Chiacu; Writing by Paul Simao; Editing by Dan Grebler)

White House expects vote on healthcare bill this week

FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S.

WASHINGTON (Reuters) – Top White House officials said on Monday they expect the U.S. House of Representatives will vote this week to pass the Republicans’ latest plan to reform the nation’s healthcare system, even as the party’s lawmakers still appeared divided over the measure.

In interviews on CBS News on Monday, White House chief of staff Reince Priebus and White House economic adviser Gary Cohn expressed optimism the latest push to unwind former Democratic President Barack Obama’s healthcare program would succeed.

“I think it will happen this week,” Priebus said on CBS “This Morning” television program.

In a separate interview, Cohn said he expected the plan to come to the House floor for a full vote. “We’re convinced we’ve got the votes, and we’re going to keep moving on with our agenda,” he said.

U.S. President Donald Trump and fellow Republicans campaigned on a pledge to repeal and replace Obama’s health care law, also known as Obamacare, but have so far failed to unite around a plan.

A reworked proposal failed to secure enough support for a vote last week. A group of hard-line Republican conservatives backed it, but more moderate conservatives remained wary.

Republican Representative Charlie Dent, a moderate from Pennsylvania, said on Monday he still had problems with the latest version of the plan and suspected there were not enough votes to pass it now.

“Too many Americans are going to be without coverage,” Dent told MSNBC.

House Freedom Caucus chairman Jim Jordan, in several television interviews on Monday, said he expected there would be enough House Republican votes to pass the bill this week.

“This bill doesn’t get all the way there but it’s a good step and is … the best we can get out of the House right now,” Jordan told CNN.

(Reporting by Susan Heavey and Doina Chiacu; Editing by Chizu Nomiyama and Jeffrey Benkoe)

U.S. Republican leaders hunt for votes for healthcare bill

U.S. House Speaker Paul Ryan speaks about healthcare at his weekly press briefing on Capitol Hill in Washington, U.S, April 27, 2017. REUTERS/Yuri Gripas

By Susan Cornwell

WASHINGTON (Reuters) – House Republicans were making headway in efforts to build support for a reworked plan to overhaul the U.S. healthcare system, but have not decided when to vote, House Speaker Paul Ryan said on Thursday.

Ryan spoke as Republican leaders scoured the U.S. Capitol in search of centrist Republican backing for the amended measure after it gained the approval on Wednesday of a group of hard-right Republican conservatives who had helped to sink the original version last month.

“We’re making very good progress,” Ryan told reporters at a news conference, saying the changes endorsed by conservative Freedom Caucus Republicans on Wednesday would also appeal to moderate Republicans.

The House could vote as early as this week on the legislation, aides said, meaning it could pass the House in time for President Donald Trump’s 100th day in office on Saturday.

It remained unclear whether the amended bill could attract the 216 votes needed to pass the House, given the united Democratic opposition. Its future is further clouded in the Senate.

“We’re going to go when we have the votes,” Ryan said.

Republicans in Congress have made repealing and replacing the Affordable Care Act, commonly known as Obamacare, a central campaign promise for seven years. Republican President Donald Trump made it a top campaign promise.

But House Republicans are not keen to repeat last month’s debacle, when their leaders acquiesced to Trump’s demand for a floor vote on the bill, only to unceremoniously yank the measure after determining it could not pass.

The Republican healthcare bill would replace Obamacare’s income-based tax credit with an age-based credit, roll back an expansion of the Medicaid government health insurance program for the poor and repeal most Obamacare taxes.

The nonpartisan Congressional Budget Office had estimated 24 million fewer people would have insurance under the original version.

The new amendment that has won over a number of conservatives, drafted by Representative Tom MacArthur, would allow states to seek federal waivers to opt out of some of the law’s provisions. That includes the highly popular provision mandating that insurers charge those with pre-existing conditions the same as healthy consumers, and that insurers cover so-called essential health benefits, such as maternity care.

Some centrists say the changes do not address their worries that the bill would hurt poor Americans in the Medicaid program. Others, including Republican Representative Dan Donovan of New York, said the loosening of protections for people with pre-existing medical conditions was a major problem.

“It’s going to cost people with pre-existing conditions even more money to have coverage … It’s something that we shouldn’t be doing,” Donovan said on CNN.

House Democrats on Thursday threatened to oppose a short-term government funding bill if the Republicans try to bring the healthcare bill to the floor this week.

Ryan brushed off this threat, even though Republicans are expected to need some Democratic votes to pass the funding bill.

House Democratic Leader Nancy Pelosi told reporters that Trump was making Republicans “walk the plank” on a healthcare bill that was “wildly unpopular.”

Ryan dismissed the idea that some Republican lawmakers’ House seats were at risk if they vote for the healthcare bill. “I think people’s seats are at risk if we don’t do what we said we would do” and repeal Obamacare, he said.

(Reporting by Susan Cornwell and Susan Heavey; Additional reporting by Amanda Becker and Will Dunham; Editing by Jeffrey Benkoe)

Trump, Republicans face tricky task of averting U.S. government shutdown

FILE PHOTO: U.S. President Donald Trump's overview of the budget priorities for Fiscal Year 2018 are displayed at the U.S. Government Publishing Office (GPO) on its release by the Office of Management and Budget (OMB) in Washington, U.S. on March 16, 2017. REUTERS/Joshua Roberts/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – President Donald Trump and his fellow Republicans who control Congress face their first major budget test next week, with the threat of a U.S. government shutdown potentially hinging on his proposed Mexican border wall as well as Obamacare funding.

With Republicans controlling the White House and both chambers of Congress, keeping the federal government operating is a basic test of their ability to govern, but their task could become even more complicated if they insist on using the spending legislation to bring about contentious policy changes.

Not only must Republicans overcome intraparty ideological divisions that stopped major healthcare legislation last month, but they will have to win over some opposition Democrats with provisions that could be distasteful to conservatives.

With the Senate reconvening on Monday and the House of Representatives on Tuesday after a two-week recess, lawmakers will have only four days to pass a spending package to keep the government open beyond April 28, when funding expires for numerous federal programs.

“I think we want to keep the government open,” Trump said on Thursday, adding he thinks Congress can pass the funding legislation and perhaps also a revamped healthcare bill.

Democratic support depends on what provisions Republicans demand in the bill. Democrats have signaled they would not cooperate if it contains money for one of Trump’s top priorities, a southwestern border wall intended to combat illegal immigration, or if it ends federal subsidies to help low-income people buy health insurance under the Affordable Care Act, known as Obamacare, which Republicans want to repeal.

Democrats also want federal funds maintained for Planned Parenthood, which many Republicans oppose because the women’s healthcare provider performs abortions. Another obstacle would be if Trump demands large defense spending increases coupled with deep cuts to domestic programs Democrats want to protect.

BALANCING ACT

Late on Thursday, leading House Democrats were voicing skepticism a deal could be reached by the deadline. In a telephone call for House Democrats, Representative Nita Lowey, the senior Democrat on the House Appropriations Committee, said: “I don’t see how we can meet that deadline” and avoid having to pass a short-term extension, according to an aide on the call.

The second-ranking House Democrat, Representative Steny Hoyer, told his fellow Democrats that they should only support such a short-term measure if a deal on long-term bill is reached and only finishing touches remained, the aide said.

Republican leaders face a familiar balancing act: satisfying the party’s most conservative members while not alienating its moderates.

Rules in the 100-seat Senate mean Trump’s party also would need the support of at least eight Democrats even if the Republicans remain unified, giving the opposition party leverage. House Republican leaders would need some Democratic votes if the most conservative lawmakers object to the bill, as they did to the healthcare plan championed by Speaker Paul Ryan.

With congressional elections looming next year, Republicans acknowledge the stakes are high.

“Even our most recalcitrant members understand that if you shut down the government while you’re running it and you control the House and the Senate, you can’t blame anybody but yourself,” said Representative Tom Cole, a senior House Appropriations Committee Republican.

White House budget director Mick Mulvaney said the Trump administration was willing to talk to Democrats about funding for Obamacare subsidies in exchange for their agreement to include some Trump priorities such as the wall, the defense hike and more money for immigration enforcement.

“It is ripe for some type of negotiated agreement that gives the president some of his priorities and Democrats some of their priorities. So we think we’ve opened the door for that,” Mulvaney said.

Democrats reacted negatively.

“Everything had been moving smoothly until the administration moved in with a heavy hand. Not only are Democrats opposed to the wall, there is significant Republican opposition as well,” said Matt House, a spokesman for Senate Democratic leader Chuck Schumer.

FURLOUGH ‘LADY LIBERTY?’

The government was last forced to close in October 2013, when Republican Senator Ted Cruz and some of the most conservative House Republicans engineered a 17-day shutdown in an unsuccessful quest to kill Democratic former President Barack Obama’s healthcare law.

“These kind of bills can’t pass without a reasonable number of the party of the minority in the Senate, and we are optimistic we will be able to work all that out,” Senate Majority Leader Mitch McConnell said at the start of the spring recess.

A deal is needed because Congress was unable to approve funding for the entire 2017 fiscal year that ends in September and has relied on stop-gap spending legislation.

Congress has passed no major legislation since Trump took office in January, and he has ambitious hopes for major tax-cut legislation, infrastructure spending and other bills.

With the difficulty passing a bill with so many divisive elements, lawmakers next week might need to buy time by passing a short-term bill lasting possibly one to three weeks, maintaining current spending levels.

“That would be a setback: not catastrophic, but not a good thing, and a sign that you can’t govern,” Cole said.

A federal closure would shutter National Park Service destinations like the Statue of Liberty, Yellowstone and the Grand Canyon. Government medical research would be suspended. Thousands of federal workers would be furloughed with thousands more working without pay until the shutdown ends, including homeland security personnel. Some veterans benefits could be suspended.

Time would stand still in the U.S. Capitol with nobody on duty to wind the 200-year-old “Ohio Clock” just outside the Senate chamber.

(Reporting by Richard Cowan and David Morgan; Editing by Kevin Drawbaugh and Will Dunham)

With ‘nuclear option,’ Senate ends Democratic blockade of Trump court pick

FILE PHOTO - U.S. Supreme Court nominee judge Neil Gorsuch testifies during a third day of his Senate Judiciary Committee confirmation hearing on Capitol Hill in Washington, U.S., March 22, 2017. REUTERS/Jonathan Ernst/File Photo

By Lawrence Hurley and Andrew Chung

WASHINGTON (Reuters) – Senate Republicans on Thursday crushed a Democratic blockade of President Donald Trump’s U.S. Supreme Court nominee in a fierce partisan brawl, approving a rule change dubbed the “nuclear option” to allow for conservative judge Neil Gorsuch’s confirmation by Friday.

With ideological control of the nation’s highest court at stake, the Republican-led Senate voted 52-48 along party lines to change its long-standing rules in order to prohibit a procedural tactic called a filibuster against Supreme Court nominees. That came after Republicans failed by a 55-45 tally to muster the 60-vote super-majority needed to end the Democratic filibuster that had sought to deny Gorsuch confirmation to the lifetime post.

The Senate’s action paved the way to confirm Gorsuch by simple majority, with a vote expected at roughly 7 p.m. (2399 GMT) on Friday. Republicans control the Senate 52-48. The rule change was called the “nuclear option” because it was considered an extreme break with Senate tradition.

Trump had encouraged Republican Senate Majority Leader Mitch McConnell to “go nuclear.” Confirmation of Gorsuch would represent Trump’s first major victory since taking office on Jan. 20, after setbacks on healthcare legislation and his blocked order to prevent people from several Muslim-majority nations from entering the United States.

“This will be the first and last partisan filibuster of the Supreme Court,” McConnell said on the Senate floor, accusing Democrats of trying to inflict political damage on Trump and to keep more conservatives from joining the high court.

“In 20 or 30 or 40 years, we will sadly point to today as a turning point in the history of the Senate and the Supreme Court, a day when we irrevocably moved further away from the principles our founders intended for these institutions: principles of bipartisanship, moderation and consensus,” Senate Democratic leader Chuck Schumer said on the Senate floor.

Schumer ridiculed McConnell’s contention that the Democratic action was unprecedented, noting that the Republican-led Senate last year refused to consider Democratic former President Barack Obama’s nomination of appellate judge Merrick Garland for the same high court seat that Trump selected Gorsuch to fill.

Senate confirmation of Gorsuch, 49, would restore the nine-seat court’s 5-4 conservative majority, enable Trump to leave an indelible mark on America’s highest judicial body and fulfill a top campaign promise by the Republican president. Gorsuch could be expected to serve for decades.

A conservative-majority court is more likely to support gun rights, an expansive view of religious liberty, abortion regulations and Republican-backed voting restrictions, while opposing curbs on political spending. The court also is likely to tackle transgender rights and union funding in coming years.

THREE DEMOCRATS

In the end, three Democratic senators up for re-election in 2018 in states won by Trump last year – Indiana’s Joe Donnelly, West Virginia’s Joe Manchin and North Dakota’s Heidi Heitkamp – broke with their party and voted with Republicans to bring about a confirmation vote, though they opposed the rule change.

The nine-seat Supreme Court has had a vacancy since conservative Justice Antonin Scalia died in February 2016.

Republicans have called Gorsuch superbly qualified and one of the nation’s most distinguished appellate judges, and they blamed Democrats for politicizing the confirmation process.

Democrats accused Gorsuch of being so conservative as to be outside the judicial mainstream, favoring corporate interests over ordinary Americans in legal opinions, and displaying insufficient independence from Trump.

The 60-vote threshold that gives the minority party power to hold up the majority party has forced the Senate over the decades to try to achieve bipartisanship in legislation and presidential appointments.

What Republicans did to Obama’s nominee Garland was worse than a filibuster, Schumer said. Schumer said Republicans denied “the constitutional prerogative of a president with 11 months left in his term.”

“The nuclear option was used by Senator McConnell when he stopped Merrick Garland. What we face today is the fallout,” Democratic Senator Richard Durbin added on the Senate floor.

McConnell blamed the escalation of fights over judicial nominees on the Democrats and their opposition starting three decades ago to nominees made by Republican former Presidents Ronald Reagan and George W. Bush.

McConnell called the Democratic effort against Gorsuch “another extreme escalation in the left’s never-ending drive to politicize the court and the confirmation process.” He accused Gorsuch’s opponents of “a singular aim: securing raw power no matter the cost to the country or the institution.”

Experts said eliminating the filibuster for Supreme Court appointments could make it more likely that presidents, with little incentive to choose centrist justices who could attract support from the other party, will pick ideologically extreme nominees in the future.

Ending the filibuster also would make it easier for future Supreme Court nominees to be confirmed when the president and Senate leadership belong to the same party.

The filibuster in one form or another dates back to the 19th century but assumed its current form in the 1970s.

While Democrats opposed the rule change and accused Republicans of a power grab, it was their party that first resorted to the nuclear option when they controlled the Senate in 2013. In the face of Republican filibusters of Obama appointments, they barred filibusters for executive branch nominees and federal judges aside from Supreme Court justices but still allowed it for Supreme Court nominees and legislation.

The Republican-backed rule change maintains the ability to filibuster legislation.

(Reporting by Richard Cowan, Lawrence Hurley and Andrew Chung; Editing by Will Dunham)

Pittsburgh cafe finds politics and coffee can leave bitter taste

Nick Miller, co-owner of the Black Forge Coffee House punches a customer loyalty card for a patron in the Allentown neighborhood of Pittsburgh, Pennsylvania, U.S., March 31, 2017. REUTERS/Maranie Staab

By David DeKok

HARRISBURG, Pa. (Reuters) – The owners of a Pittsburgh coffee shop found out the hard way that in the hyper-polarized political climate of 2017, punching holes in pictures of President Donald Trump and other conservative stalwarts is no laughing matter for some.

The Black Forge Coffee Shop has been fielding phone calls this week from people around the country upset about the cafe’s customer loyalty cards featuring a who’s who of prominent conservatives, according to its owners.

The idea puts a topical twist on a familiar perk: Buy a coffee and the store punches a hole through a photo of Trump, Vice President Mike Pence or one of the others. After all 10 conservatives are punched, the customer gets a free cup.

“We wanted to do something unique that would stand out,” said Nick Miller, who has run the shop with his business partner Ashley Corts for about 18 months. “It’s not a statement; it’s really just a joke.”

More than a few people apparently were not amused.

While some people were calling the shop to voice their displeasure, others emailed images of the owners’ faces superimposed with targets. Disparging comments about the shop suddenly started popping up Facebook and Yelp.com.

“HORRIBLE PLACE,” Yelp user Alexis K. of Oceanside, California, wrote. “I refuse to support a busines who can act this way about our president who WE ELECTED fair and square.”

In addition to Trump and Pence, the cards feature the likenesses of Senator Ted Cruz and Rick Santorum, a former U.S. senator from Pennsylvania. Rounding out the gallery are five conservative commentators: Ann Coulter, Rush Limbaugh, Bill O’Reilly, Mike Huckabee and Pat Robertson, as well as controversial pharma executive Martin Shkreli.

The shop has been handing out the cards for months, but the deluge of calls, many of them abusive, only started after Fox News picked up the story on Wednesday, the co-owner says.

Fortunately, no one who has come into the shop in person has been abusive to the staff, said Miller, a Democratic voter.

It may help that Black Forge is next door to a Pittsburgh police stations, and many officers are regular customers, Miller said.

“They thought it was pretty funny,” he said. “They were surprised no one could see it was just a joke.”

Despite the ire that the cards have stirred up, Miller said he has no regrets. After all, publicity is publicity – and business is booming, he said.

(Editing By Frank McGurty and Cynthia Osterman)

How Republicans can hobble Obamacare even without repeal

People march in a "Save Obamacare" rally in Los Angeles.

By Julie Steenhuysen

CHICAGO (Reuters) – Republicans may have failed to overthrow Obamacare this week, but there are plenty of ways they can chip away at it.

The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.

Earlier this week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.

The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.

The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law. Price’s power resides in how to interpret that law, and which programs to emphasize and fund.

Hospitals and physician groups have been counting on support from Medicare – the federal insurance program for the elderly and disabled – to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.

The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.

Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government’s blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.

Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.

Price “can’t change the legislation, but of course he’s supposed to implement it. He could impact it,” said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.

The move Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday “will soon explode.”

“It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.

“The ACA marketplaces weren’t collapsing, but they could be made to collapse through administrative actions,” he added.

NEW PAYMENT PLANS AT RISK

The United States spends $3 trillion a year on healthcare – more by far than 10 other wealthy countries – yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report.

Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient’s health improves.

“We have a completely broken economy in healthcare,” said Blair Childs, senior vice president at hospital purchasing group Premier Inc. “Literally, all of the incentives in fee-for-service are for higher cost.”

Alternative payment models are designed to remove incentives that reward overtreatment of patients. Private insurers are on board, with Aetna Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers announcing plans to shift half of their reimbursement to alternative payment models to control costs.

To promote the shift to alternative payments, the ACA created an incubator program at the Centers for Medicare Medicaid Services (CMS). The CMS innovation center is funded by $10 billion over 10 years to test payment schemes aimed at improving quality and cutting the cost of care.

The Obama administration’s decision to make some of these payment programs mandatory has drawn the ire of Price, a former U.S. senator and orthopedic surgeon. In response to a mandatory payment program for joint replacements last September, for example, Price charged that the CMS innovation center was “experimenting with Americans’ health.”

In his January 17 confirmation, Price said he was a “strong supporter of innovation,” but said he believed the CMS innovation center “has gotten a bit off track.”

TRUMP SETS WHEELS IN MOTION ON DAY 1

President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law.

The order directed departments to “waive, defer, grant exemptions from, or delay the implementation” of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.

David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.

“If he wants to blow it up, he can,” Cutler said in an email. But if they do, he added, “they alone will own the failure.”

(Editing by Edward Tobin)

Trump warns Republican lawmakers of backlash for healthcare failure

U.S. President Donald Trump (C) and Health and Human Services Secretary Tom Price (L) enter the U.S. Capitol in Washington, U.S., March 21, 2017. REUTERS/Kevin Lamarque

By Susan Cornwell

WASHINGTON (Reuters) – U.S. President Donald Trump warned Republican lawmakers on Tuesday that voters could punish them if they do not approve a plan he favors to dismantle Obamacare, as pressure grew on the businessman-turned-politician to win the first major legislative battle of his presidency.

In one of the few visits he has made to the U.S. Capitol since taking office, Trump told fellow Republicans in the House of Representatives they would face “political problems” for opposing the bill that takes apart Obamacare and partially replaces it.

“The president was really clear: he laid it on the line for everybody,” House Speaker Paul Ryan, the leading proponent of the bill, told reporters. “We made a promise. Now is our time to keep that promise … If we don’t keep our promise, it will be very hard to manage this.”

While Republicans control both chambers of Congress, the party’s leaders face a difficult task in uniting their members behind the healthcare bill, just the first of a series of reforms that Trump has promised including overhauls of the tax system and business regulations.

U.S. stocks turned sharply lower on Tuesday, led by a fall in financial shares, as investors began to question how quickly the Trump administration can implement pro-growth policies.

Sectors that could benefit from policies of lower taxes and fiscal stimulus were weaker as investors perceived those plans may take longer to implement if the Trump administration has to expend more time and energy to get a healthcare plan passed.

Some conservatives believe the healthcare bill does not go far enough, while moderate Republicans worry it goes too far and that millions of Americans will be hurt by dismantling the 2010 Affordable Care Act, former President Barack Obama’s signature healthcare legislation.

Party leaders hope to move the bill to the House floor for debate as early as Thursday. But the administration and House leadership can afford to lose only about 20 votes from Republican ranks or risk the bill failing since Democrats are united against it.

Repealing and replacing Obamacare was one of Trump’s main campaign promises and has been a goal of Republicans since it was enacted. Trump, who took office two months ago, has yet to push any major legislation through Congress.

Republican Representative Walter Jones said Trump told lawmakers in a closed-door meeting that if the Republican bill does not pass, they would face “political problems.” Jones said he thought Trump meant lawmakers could lose their seats.

While Trump predicted that Republicans could face challenges in primary contests ahead of the 2018 midterm elections if they do not gut Obamacare, there is also danger to them in doing so. Millions of voters might lose their healthcare coverage if the Republican bill is passed.

The Congressional Budget Office said last week that 14 million people would lose coverage under the House bill over the next year, although that number could change based on the most current version of the legislation.

CRITICS REMAIN

Republican leaders recrafted the bill on Monday to satisfy critics, mainly fellow Republicans, in part by proposing major changes to tax credits and provisions to alter the Medicaid publicly funded insurance program for low-income people.

Representative Bill Flores said Trump singled out one critic on the right flank of the party, Mark Meadows, chairman of the conservative House Freedom Caucus, during his Capitol Hill visit, saying Meadows would eventually come around to vote for the bill.

“Mark Meadows, he called out two or three times,” Flores told reporters. “The reaction, when he said, ‘Mark Meadows, I’m coming after you’, was pretty loud cheers … I think he was tongue-in-cheek, half joking.”

Despite Monday’s changes, the Wall Street Journal reported the House Freedom Caucus has enough votes to block the bill.

Trump, who has not offered Obamacare repeal legislation of his own, did not talk “a whole lot about the healthcare bill except to vote for it,” Jones said.

The Club for Growth, an influential conservative lobby group, said it would spend at least $500,000 for ads on television and digital platforms urging members of Congress to defeat the bill.

The Senate will also vote on the legislation and more changes could still be made.

At a rally in Kentucky on Monday night, Trump said he wanted to add a provision to the bill to lower prescription drug costs through a competitive bidding process. There was no such provision in Monday’s changes.

Republican chairmen for two key committees said late Monday they proposed more funding for tax credits, which conservatives have opposed, that would give the Senate flexibility to help older people afford health insurance. Additionally, Obamacare’s taxes would be eliminated in 2017 instead of 2018.

Monday’s amendments also addressed Medicaid, which is the country’s largest health insurance program and covers about 70 million people, mostly the poor. The changes would allow states to implement work requirements for certain adults and to decide how they receive federal funds.

The nonpartisan Congressional Budget Office, which said last week the original bill would cause 24 million people to lose coverage over the next decade, is expected to update its analysis of the legislation to include the proposed changes.

Democrats oppose Republicans’ plan, saying it would throw millions off health insurance and hurt the elderly, poor, and working families while giving tax cuts to the wealthy.

(Additional reporting by Jeff Mason Susan Heavey, Yasmeen Abutaleb and Richard Cowan; Writing by Alistair Bell; Editing by Bill Trott and Frances Kerry)

Republicans revamp U.S. health bill, boost benefits to older Americans

Speaker of the House Paul Ryan (R-WI) speaks to the media on Capitol Hill in Washington, U.S., March 16, 2017. REUTERS/Joshua Roberts

By Susan Cornwell and Valerie Volcovici

WASHINGTON (Reuters) – U.S. House Republicans are working on changes to their healthcare overhaul bill to provide more generous tax credits for older Americans and add a work requirement for the Medicaid program for the poor, House Speaker Paul Ryan said on Sunday.

Ryan said Republican leaders still planned to bring the healthcare bill to a vote on the House of Representatives floor on Thursday. Speaking on the “Fox News Sunday” television program, he said leaders were working to address concerns that had been raised by rank-and-file Republicans to the legislation.

Republicans remain deeply divided over the healthcare overhaul, which is President Donald Trump’s first major legislative initiative. It aims to fulfill his campaign pledge to repeal and replace the Affordable Care Act, popularly known as Obamacare, the signature healthcare program of his Democratic predecessor, Barack Obama.

Democrats say the Republican plan could throw millions off health insurance and hurt the elderly, poor and working families while giving tax cuts to the rich.

“We think we should be offering even more assistance than the bill currently does” for lower-income people age 50 to 64, Ryan, the top Republican in Congress, said of the tax credits for health insurance that are proposed in the legislation.

Ryan also said Republicans were working on changes that would allow federal block grants to states for Medicaid and permit states to impose a work requirement for able-bodied Medicaid recipients.

Trump told reporters in a brief conversation aboard Air Force One that he had meetings about healthcare reform in Florida at the weekend and that the effort to sell the proposal was going well.

He has been wooing lawmakers to vote for the bill and won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid.

Trump is set to meet Ezekiel Emanuel, a health policy special adviser under Obama who helped shape the Affordable Care Acton, at the White House on Monday, along with Ryan and Health and Human Services Secretary Tom Price.

Block grants would give states a set amount of money to cover people on the Medicaid program and provide flexibility in spending decisions. However, there is no guarantee funding would keep up with future demands.

“TRYING TO FIX BILL”

While Ryan said he felt “very good” about the health bill’s prospects in the House, a leading conservative lawmaker, Representative Mark Meadows, told the C-Span “Newsmakers” program that there were currently 40 Republican “no” votes in the House. Republicans hold a majority in the chamber but cannot afford to have more than 21 defections for the measure to pass.

Meadows and two other Republican opponents of the bill, Senators Mike Lee of Utah and Ted Cruz of Texas, met at Trump’s Mar-a-Lago estate in Florida on Saturday “negotiating with the president’s team, trying to fix this bill,” Cruz told CBS’ “Face the Nation.”

North Carolina Republican Meadows said the changes being considered for the Medicaid program would not go far enough if they left it up to states to decide whether to put in place a work requirement.

Price acknowledged the tough negotiations, telling ABC’s “This Week”: “It’s a fine needle that needs to be thread, there’s no doubt about it.”

The healthcare bill would face significant challenges in the Senate even if it were to pass the House.

Senator Tom Cotton, a conservative Arkansas Republican, said the bill would not reduce premiums for people on the private insurance market. “It’s fixable, but it’s going to take a lot of work,” Cotton said on CNN’s “State of the Union.”

Moderate Republicans have also expressed concerns about the bill, and their worries are often not the same as that of conservatives.

Speaking on NBC’s “Meet the Press,” Republican Senator Susan Collins of Maine worried the bill would harm older Americans, and shift Medicaid costs to states – something critics say a block-grant approach would only make worse.

Collins said coverage issues must also be dealt with, citing a report from the Congressional Budget Office that said 14 million people would lose health coverage under the House bill over the next year and 24 million over the next decade.

Affordability has been one of the bigger concerns that insurers and hospital groups have raised about the legislation. To the extent that a change in tax credits makes healthcare more affordable for some people, insurers and hospitals could stand to benefit.

The BlueCross BlueShield Association emphasized the need for the replacement to be affordable when the draft of the healthcare bill was released earlier this month. The association represents BCBS insurers that cover the vast majority of the roughly 10 million people enrolled in 2017 Obamacare plans.