WASHINGTON — House Speaker Paul Ryan labored to rally divided Republicans behind a high-stakes drive to overhaul the nation's health care system Wednesday, praising his party's legislation as "what good, conservative health care reform looks like" as lawmakers cast Congress' first votes.
Republicans who control two crucial House committees — Ways and Means, and Energy and Commerce — but hit a torrent of resistance from Democrats who oppose the seven-year GOP effort to unravel former President Barack Obama's health care law.
The outnumbered Democrats used the panels' sessions for political messaging, saying Republicans would cut taxes on the rich while slicing the Medicaid program for the poor. The Democrats even tried, unsuccessfully, to insert language pressuring President Donald Trump to release his income tax returns.
The pivotal challenge for Republican leaders was coming not from the Democrats but from a rebellion in their own ranks and from potent outside groups. If that upheaval should snowball and crush the legislation, it would be a shattering defeat for Trump and the GOP, so leaders were hoping passage by both House committees this week would provide them with momentum.
Just as ominous as GOP unrest was hostility from three organizations instrumental in the 2010 enactment of Obama's overhaul: The American Medical Association, the American Hospital Association and AARP, the nation's largest advocacy group for older people.
In words aimed at his own recalcitrant colleagues, Ryan, R-Wis., declared the legislation "is bold and it is long overdue. And it is us fulfilling our promises." The last was a nod to campaign pledges by Trump and many GOP congressional candidates.
There were signs of growing White House engagement.
A day after Trump pledged his backing to House GOP vote counters, conservatives who'd met late Tuesday with White House budget chief Mick Mulvaney flashed optimism that the bill could be reworked. Rep. Trent Franks, R-Ariz., told reporters that Mulvaney said that "essentially whatever the Congress could do to improve the bill, that the White House was open."
Underscoring Trump's potential impact, Energy and Commerce Chairman Greg Walden, R-Ore., said of GOP holdouts, "A lot of them, they maybe haven't felt the inertia that comes with Air Force One landing in their district."
The legislation would defang Obama's requirement that everyone buy insurance — a provision deeply disliked by Republicans — by repealing the tax fines imposed on those who don't. That's a stick aimed at pressing healthy people to purchase policies. The bill would replace income-based subsidies Obama provided with tax credits based more on age, and insurers would charge 30 percent higher premiums for customers who drop coverage for over two months
The extra billions Washington has sent states to expand the federal-state Medicaid program would begin ending in 2020, and spending on the entire program would be capped at per-patient limits. Around $600 billion in the 10-year tax boosts that Obama's statute imposed on wealthy Americans and others to finance his overhaul would be repealed. Insurers could charge older customers five times more than younger ones instead of the current 3-1 limit, but would still be required to include children up to age 26 in family policies, and they would be barred from imposing annual or lifetime benefit caps.
Democrats say the Republicans would yank health coverage from many of the 20 million Americans who gained it under Obama's statute, and drive up costs for others because the GOP tax breaks would be skimpier than existing subsidies. And they accused Republicans of hiding bad news by moving ahead without official estimates from the nonpartisan Congressional Budget Office on the bill's cost to taxpayers and anticipated coverage.
"The bill sabotages the marketplaces where close to 10 million Americans today get coverage and starts a death spiral from which we will never recover," said Ways and Means' top Democrat, Richard Neal of Massachusetts.
On the Republican side, conservatives in particular were up in arms, saying the tax credits would be too expensive and the phase-out of Obama's Medicaid expansion too slow. One conservative group, FreedomWorks, was launching digital and social media ads opposing the legislation, while others like Americans for Prosperity, backed by the wealthy Koch brothers, were working against the legislation.
"It's way more cost and we're already bankrupt," Rep. Dave Brat, R-Va., said of the GOP measure.
Numerous GOP centrists and governors were also antagonistic, worried their states could lose Medicaid payments and face higher costs for hospitals having to treat growing numbers of uninsured people.
Buttressing Republicans, the U.S. Chamber of Commerce was backing the bill. The American Action Network, a political group tied to House GOP leaders, has spent nearly $8 million this year on TV and digital ads supporting the legislation in 75 House districts, mostly held by Republicans.