WASHINGTON -- The House Budget Committee on Thursday narrowly voted 19-17 to advance to the House floor a Republican bill to overhaul the Patient Protection and Affordable Care Act, as some conservatives registered their opposition.
Three Republicans opposed the motion -- Reps. Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina -- all of them members of the House Freedom Caucus, a group of hard-right lawmakers. All Democrats voted against the motion.
Reps. Bruce Westerman and Steve Womack from Arkansas voted to advance the measure.
After the vote, the committee continued discussing the measure. Republican members are expected to propose revisions to help smooth the bill's passage through the House.
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Budget Committee Chairman Diane Black, R-Tenn., called the legislation "the conservative health-care vision that we've been talking about for years" in her opening remarks, and she urged Republican skeptics on the panel to have an open mind. She called the bill a "good first step."
Democrats spoke vehemently against the plan. "This is Robin Hood in reverse but far worse," said Rep. John Yarmuth of Kentucky, the top-ranking Democrat on the committee. He highlighted a Congressional Budget Office analysis this week that projected that millions fewer Americans would be insured after one year under the plan.
The committee may not directly amend the bill but may make nonbinding recommendations. Any substantive changes would be made by the House Rules Committee, which controls how the measure is presented and debated on the floor.
Womack said during a break in the proceedings that passing legislation to repeal and replace the Affordable Care Act is "incredibly important."
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"There are so many provisions in this act that Republicans have campaigned on and have promised. Here we are on the eve of being able to accomplish [them]," he said. "The alternative is that we are stuck with Obamacare, and I don't think anybody wants to see that happen."
Westerman said he was glad that Budget Committee members were able to recommend changes to the legislation. The Rules Committee will decide whether to include them in the bill, he added.
"When it went through [the] Ways and Means [Committee] and [the] Energy and Commerce [Committee], there were no amendments even voted on, so I think we've made a lot of progress," he said.
Westerman said he was pleased that the Budget Committee favored creation of a block grant option that would give states broad discretion over how they spend their Medicaid dollars.
Westerman submitted a letter, signed by Arkansas Gov. Asa Hutchinson, calling for this type of option. Hutchinson wrote that a block grant program would allow states to use the money more effectively and "generate significant savings for the federal government and the states."
As the bill heads to the full House, Republican congressional leaders turned to President Donald Trump on Thursday to wrangle support to push the legislation through Congress before Easter.
But Trump suggested Wednesday that he wasn't ready to close the deal and that final passage of the bill could be delayed
"It's very preliminary," the president said of the House GOP bill in a Fox News Channel, when questioned about reports the legislation would help Democratic voters more than those who elected him. "A lot of things aren't consistent. But these are going to be negotiated. ... We will take care of our people or I'm not signing it, OK, just so you understand."
The House GOP bill repeals elements of that law, including the "individual mandate" that penalizes people who don't have insurance. It sets up a new system of tax credits that is less generous, particularly to older Americans. It eliminates some of Obamacare's requirements for services health plans need to cover, and it sunsets an expansion of Medicaid over several years, an element causing great consternation with moderate-leaning Republicans but one that conservatives want to move up faster.
The bill also cuts a slew of taxes, mostly to the benefit of the rich. Conservatives say it doesn't go far enough in repealing the Obama-era law in full.
Nevertheless, House Speaker Paul Ryan tried to strike an optimistic tone as he addressed reporters Thursday for his weekly press briefing.
"We feel like we're making great strides and great progress on getting a bill that can pass," Ryan said.
But Ryan did not commit to a timetable for passage, and his acknowledgment that the bill needs changes to pass was itself a change. Last week, Ryan was pledging action next week by the House Rules Committee -- the precursor to a floor vote -- and confidently predicting the bill would have the votes to pass.
Instead, Ryan spent part of his news conference disputing suggestions that he and Trump are at odds over the health bill, rumblings that originate with Ryan's very reluctant support for Trump during the presidential campaign.
"There is no intrigue, palace intrigue, divisions between the principals ... there really is no schism whatsoever," Ryan said. "I'm excited at the fact that we have a president who likes closing deals."
Information for this article was contributed by Mike DeBonis, Sean Sullivan, Kelsey Snell, Elise Viebeck and David Weigel of The Washington Post; by Erica Werner, Alan Fram, Ken Thomas, Richard Lardner and Kevin Freking of The Associated Press; and by Frank E. Lockwood of the Arkansas Democrat-Gazette.
A Section on 03/17/2017