Hospitals, doctors and consumer groups mounted intensifying opposition to the Republican health care bill as GOP leaders labored Wednesday to rally a divided party behind their high-stakes overhaul drive. Lawmakers cast Congress' initial votes on the legislation as House Speaker Paul Ryan praised the proposal as "what good, conservative health care reform looks like."
The American Medical Association, the American Hospital Association and AARP, the nation's largest advocacy group for older people, were arrayed against the GOP measure. Seven years ago their backing was instrumental in enacting President Barack Obama's health care statute, which President Donald Trump and congressional Republicans are intent on erasing.
The hospitals — major employers in many districts — wrote lawmakers complaining about the bill's cuts in Medicaid and other programs and said more uninsured Americans seem likely, adding, "We ask Congress to protect our patients." Groups representing public, children's, Catholic and other hospitals also expressed opposition.
America's Health Insurance Plans, representing insurers, praised GOP provisions like erasing health industry taxes but warned that proposed Medicaid changes "could result in unnecessary disruptions in the coverage and care beneficiaries depend on."
In epic sessions that stretched past midnight into Thursday morning, leaders began pushing the legislation toward passage by two House committees — Ways and Means, and Energy and Commerce.
GOP leaders faced rebellion within their own ranks, including from conservative lawmakers and outside conservative groups. Top Republicans knew if the upheaval should snowball and crush the legislation it would be a shattering defeat for Trump and the GOP, so leaders hoped approval by both House committees would give them momentum.
In words aimed at recalcitrant colleagues, Ryan, R-Wis., told reporters: "This is what good, conservative health care reform looks like. It 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.
Outnumbered Democrats used the panels' meetings for political messaging, futilely offering amendments aimed at preventing the bill from raising deficits, kicking people off coverage or boosting consumers' out-of-pocket costs. They tried unsuccessfully to insert language pressuring President Donald Trump to release his income tax returns, and failed to prevent Republicans from restoring insurance companies' tax deductions for executive salaries above $500,000 — a break Obama's law killed.
There were signs of growing White House engagement, and perhaps progress.
Trump met at the White House late Wednesday with leaders of six conservative groups that have opposed the GOP legislation, and several voiced optimism afterward.
"I'm encouraged that the president indicated they're pushing to make changes in the bill," said David McIntosh, head of the Club for Growth, though he provided no specifics.
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 penalty has been 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 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 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.
"We will answer President Trump's call to action," said Ways and Means Chairman Kevin Brady, R-Texas, adding later, "Relief is on the way."
Democrats said 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.
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.