A constellation of influential groups representing the nation’s hospitals and physicians came out Wednesday against a House Republican proposal to overhaul the Affordable Care Act, marking the latest round of setbacks to the controversial plan.
Seven groups speaking on behalf of hospitals, health systems and medical colleges collectively added their “significant concerns” to the growing opposition, focusing on the prospect of sharply lower numbers of insured Americans if the GOP plan becomes law. Separately, the American Medical Association, a powerful lobbying group for physicians, rejected the bill for the same reason.
The new round of opposition underscored the challenge that proponents of the bill, known as the American Health Care Act, are facing. It came as the White House and House Republican leaders moved to try to overcome the surge of hostility to the measure from conservatives, Democrats and industry groups, while two House committees started debating the bill.
In a letter to Congress, the hospital groups, which included the American Hospital Association, wrote, “Our assessment of this legislation as currently drafted is that it is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance or maintain coverage under the Medicaid program.” They said they anticipated “tremendous instability for those seeking affordable coverage.”
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The groups also addressed the proposed changes to Medicaid, warning that they would mean lost coverage and funding cuts for a program charged with caring for vulnerable children, elderly and disabled Americans.
AMA chief executive James L. Madara, a doctor, wrote a letter to congressional leaders released Wednesday expressing the same sentiment: “We cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”
The list of organizations and lawmakers opposing the measure has grown quickly since the bill, which would repeal key parts of the ACA, was unveiled on Monday. The AARP came out against it Tuesday. Conservative advocacy groups such as Heritage Action for America, FreedomWorks and the Club for Growth have also rejected it.
White House press secretary Sean Spicer said Wednesday that administration officials, including President Trump, are engaged in a “full-court press” to sell the bill through local radio and television interviews and meetings with stakeholders.
On Capitol Hill, Speaker Paul D. Ryan (R-Wis.) expressed confidence the bill would eventually pass, even though some conservative House GOP members have railed against it, complaining it does not undo the ACA aggressively enough.
Trump planned to host a group of conservative leaders at the White House Wednesday night to discuss their concerns, Spicer said — the second night in a row Trump has huddled with players in the debate to discuss strategy.
At the same time, Spicer sought to pre-emptively discredit the Congressional Budget Office, a nonpartisan analyst that is preparing to report on how much the bill will add to the federal deficit. Next week, it will also forecast how many people could lose coverage if the measure is enacted.
“If you’re looking to the CBO for accuracy, you’re looking in the wrong place,” Spicer said, accusing the office of mistakes in its forecasts about the ACA.
Ryan described the proposal as a “conservative wish list” that would deliver on years of GOP campaign promises to reform the nation’s health-care system.
“This is the covenant we made with the American people when we ran on a repeal-and-replace plan in 2016,” he said at a news conference Wednesday on Capitol Hill. He later added: “I have no doubt we’ll pass this, because we’re going to keep our promises,” he said.
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The developments highlighted the high stakes confronting Ryan as the committee work got underway. Republican leaders face stiff opposition to their proposal from both the left and the right.
In addition to the conservative complaints, Democrats decry the plan’s expected toll on vulnerable populations, and conservative Republicans say it would not go far enough in pulling back elements of the ACA. Moderate Republicans have also have pushed back on the plan, fearing it will harm those who obtained coverage under the ACA’s expansion of Medicaid.
“I do not think it will be well received in the Senate,” Sen. Susan Collins (R-Maine), a centrist, told Yahoo News.
By midday, the two House committees working on the bill were experiencing the kinds of partisan skirmishes expected to dominate the process over the next several weeks. The lack of a CBO score was a flashpoint in the committee hearings.
In a meeting of the House Ways and Means Committee, Democrats moved immediately to lambaste the bill and the process that produced it.
Rep. Lloyd Doggett (D-Tex.) offered a motion to delay the hearing for one week to allow for further hearings on the bill and to examine the CBO report. The motion was voted down on a straight party-line vote.
“Health care is too important, it impacts too many lives, to have a health-care bill jammed though in the same manner as President Trump’s immigration order,” Doggett said. “What this bill needs is some extreme vetting.”
The hearing dragged slowly into the afternoon with Democrats and Republicans repeatedly butting heads over the fairness of the process rather than the content of the legislation. The grinding process was occasionally punctuated with levity when Democrats offered amendments that were exact copies that GOP members offered in 2009 when the ACA was written.
In the House Energy and Commerce Committee, Democrats engaged in another procedural protest as they questioned why the majority had constrained most members to one-minute speeches, rather than three-minute speeches.
In a sign of how strained relations between the two parties have become, New Jersey Rep. Frank Pallone Jr., the panel’s top Democrat, repeatedly sparred with Chairman Greg Walden (R-Ore.) over parliamentary procedure once the House bill was called up for consideration.
As Pallone peppered Walden with questions and said Democrats were prepared to offer roughly 100 amendments, the Oregon Republican replied in an exasperated tone. “We’ll get through this,” he said. “Let’s all just settle down.”
But Democrats continued to press their objections, demanding that the committee clerk read the revised legislative proposal word-for-word rather than skip that step for the sake of time, as is customary.
An unlikely focal point in the House Energy and Commerce committee markup was the health panel’s chief counsel, Paul Edattel, who became the constant referee between Democrats and Republicans fighting out their differences over the bill by peppering him with factual questions about it.
White House Budget Director Mick Mulvaney played down worries about the missing cost estimate, predicting it would arrive Monday and noting that because the health-care plan is being considered under a special budget procedure known as reconciliation, it cannot increase the federal deficit after a period of 10 years.
“We all know [the bill] is going to score positive in helping out the deficit, to spending less money, another thing that conservatives should be supportive of,” Mulvaney said on MSNBC. “So I hear all the talk about the CBO score. The only question about the CBO: Is it going to be really good or is it going to be great when that number finally comes out?”
Ryan has a major ally in his corner — Trump, who wants the House bill approved quickly and without significant changes and has warned that not doing so will result in trouble for Republicans at the ballot box.
The White House has already spent several days targeting skeptical conservatives in a behind-the-scenes “charm offensive,” said Sen. Rand Paul (R-Ky.), who has emerged as the bill’s chief skeptic.
“Every conservative that’s come out publicly opposed to this has been called by the White House and is being cajoled and wooed by the White House to give in,” Paul said during an interview with MSNBC on Wednesday.
“But if conservatives stick together … we will have a force and a negotiation,” he said. “Because I don’t think they have the numbers to pass this at this point.”
Trump specifically called out Paul with a tweet Tuesday evening: “I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!”
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Ryan has outlined three phases in which health-care reform would be achieved: first, via reconciliation, of which the current measures are a part; then, through regulations at the Department of Health and Human Services; and finally, the passage of other bills that would need more backing and could include the ability to buy insurance across state lines, a priority for conservatives.
Some Republican senators have complained that the process is still moving too quickly.
“I want to get it right. I don’t want to get it fast. And the Senate certainly will not just be jammed with whatever the House sends over here,” said Sen. Tom Cotton (R-Ark.) on MSNBC.
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Elise Viebeck, Kelsey Snell, Dave Weigel, Karoun Demirjan and Robert Costa contributed to this report.
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