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story.lead_photo.caption FILE - In this March 8, 2017, file photo, House Paul Ryan, of Wis., speaks during a news conference at Republican National Committee Headquarters on Capitol Hill in Washington. Ryan said he will seek changes to a divisive GOP health care bill to provide more help to older people hard hit by the plan. A Congressional Budget Office analysis concluded that older people would likely pay higher premiums under the proposal to repeal and replace Barack Obama's health care law. (AP Photo/J. Scott Applewhite, File)

WASHINGTON -- Days before a pivotal House vote, Speaker Paul Ryan said Sunday that he will seek changes to a GOP health care bill to give older Americans more assistance to buy insurance.

The willingness to compromise on the American Health Care Act was a bid for more support from moderate Republicans, who expressed unease about the plan to replace former President Barack Obama's health law and called for significant changes to be made.

Ryan acknowledged on Fox News Sunday that House leadership was "making fine-tuning improvements to the bill to reflect people's concerns," but he insisted that he felt "very good" about the bill's prospects.

Part of the confidence stems from President Donald Trump's involvement in "helping us close this bill," Ryan said.

[INTERACTIVE: Compare new health care proposal with Affordable Care Act]

"We have a president who is rolling up his sleeves. ... He's helping us make sure that we bridge differences with members who are bringing constructive ideas and solutions for how to make this bill better," Ryan said.

Ryan said he would "most likely" take the bill forward for a floor vote Thursday. He expressed confidence that the bill would pass in the House and move on to the Senate.

"The president is bringing people to his table, and I'm very impressed with how the president is helping us close this bill, and making the improvements that we've been making, getting the votes," Ryan said. "We are right where we want to be."

Rep. Steve Scalise, the Louisiana Republican who serves as majority whip, sent out a message late Sunday to encourage House Republicans to support the repeal of the law popularly called Obamacare.

[PRESIDENT TRUMP: Timeline, appointments, executive orders + guide to actions in first 100 days]

"These next few days could define us for years to come," he said. "The American Health Care Act needs to pass the House of Representatives so the American people can be rescued from Obamacare."

He encouraged fellow Republicans pushing for support from House colleagues to "remind members that attacks from the Left are nothing new, and rarely accurate." He told them: "This is our moment to make history."

Health and Human Services Secretary Tom Price said legislative revisions were possible to help the bill pass.

But on ABC's This Week, Price acknowledged that changes to the House bill could cost Republican votes in the Senate, where the GOP holds a 52-48 majority.

"It's a fine needle that needs to be threaded," Price said.

Lawmaker opposition

Sen. Susan Collins, R-Maine, said on NBC's Meet the Press that she would not vote for the measure without additional changes to provide more aid to older Americans. She also wants a proposal that would cover more Americans and offer better Medicaid benefits than the current GOP plan.

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She joins several other GOP senators in opposing the bill. Conservative Sen. Ted Cruz of Texas said Sunday on CBS' Face the Nation that he wouldn't vote for it as is. Sens. Dean Heller of Nevada, Mike Lee of Utah and Rand Paul of Kentucky are also opposed to the plan that would repeal the Patient Protection and Affordable Care Act.

"I cannot vote for any bill that keeps premiums rising," Cruz said. "If Republicans hold a big press conference and pat ourselves on the back that we've repealed Obamacare and everyone's premiums keep going up, people will be ready to tar and feather us on the streets, and quite rightly."

Cruz said he and two other conservative leaders -- Lee and Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus -- met at Trump's Mar-a-Lago resort in Florida in an attempt "to fix this bill."

"President Trump said this is one big, fat negotiation," Cruz said. "Here is the central prize: If we lower premiums, and hopefully lower them a lot, that is a victory for the American people."

Sen. Tom Cotton, R-Ark., has said that voting for the measure as written may imperil the party's majority in the House in the 2018 midterm elections. He said Sunday that he didn't believe the bill would lower premiums for working people.

"It's fixable, but it's going to take a lot of work," Cotton said on CNN's State of the Union. "We need to roll up our sleeves and focus on fixing those problems, rather than trying to rush to some arbitrary deadline."

Paul said he was concerned that the House plan includes bailouts for insurance companies.

"We're for empowering the consumer to drive prices down so you can get better-cost insurance. But we're not for, when you get sick, the taxpayer takes over the tab for the insurance company," Paul said. "It's a terrible situation. What you do is you socialize the insurance company losses, but you privatize the billions of dollars that they make. I'm not for giving a gift to the insurance companies, and that's what this House plan does."

Paul said he handed out notes based on Trump's book The Art of the Deal at a meeting with Freedom Caucus members last week: "We need to learn from the master, and let's make sure that we increase our leverage by holding the line."

Last week, Trump agreed to add more Medicaid curbs to appease some conservatives. On Sunday, Trump told reporters aboard Air Force One that efforts to sell the bill are "going well, had a lot of meetings on that."

But in a Facebook post Saturday night, Rep. Brian Fitzpatrick, R-Pa., said he couldn't vote for the bill, stressing a need "to take our time and to get this right." He joins GOP Rep. John Katko, from a closely divided district in upstate New York, who cited inadequate insurance access and cost controls.

House Democratic Leader Nancy Pelosi said the Affordable Care Act can be improved and that Republicans could work with Democrats to do it. Instead, she said, the bill championed by Republicans would hurt "millions of people who are benefiting" from the current law and who voted for Trump, and hand tax breaks to wealthy people in regions that voted for Democrat Hillary Clinton.

"That money will be taken from red areas, and many of the people who will be advantaged by the money going to the high end will be in blue areas," the California lawmaker said on Face the Nation. "How's that? It's so wrong."

Mick Mulvaney, the White House budget director, countered that Trump voters and everyone else would be better off under the Republican bill. It provides tax-credit assistance and would spur increased competition to reduce costs, he said.

"We know who his voters are. And we're going to take care of them," Mulvaney said on CBS. "But that doesn't mean we're leaving Obamacare in place because that would actually hurt them dramatically."

Losing assistance

Under the GOP plan, people in the 50-64 age group who are not yet eligible for Medicare stand to lose the most assistance. The plan would shrink the tax credits they use to help buy insurance and would increase their premiums, because the bill allows insurers to charge more as people age and become more susceptible to health problems.

A Congressional Budget Office analysis last week said a 64-year-old with income of $26,500 would pay $1,700 out of pocket for insurance under the Affordable Care Act, compared with $14,600 under the GOP plan. The Republican plan would allow insurers to charge older customers up to five times more than younger customers, compared with up to three times more under the Affordable Care Act. Supporters of the 5-to-1 ratio say it will help insurers attract more of the young, healthy customers whom insurers want.

The GOP bill as currently written offers a fixed tax credit for low- and middle-income Americans that rises based on the consumer's age. Under the Affordable Care Act, the tax credit rises or falls along with health insurance premiums. If premiums rise but a person's income does not, then his out-of-pocket costs do not increase.

That, according to the Congressional Budget Office estimate, leads to substantial cost savings that -- together with cuts to Medicaid -- allow the GOP plan to eliminate nearly all of the taxes imposed under the Affordable Care Act. But those Medicaid cuts have worried some lawmakers.

The Congressional Budget Office estimated that over 10 years, 24 million fewer people would have coverage.

On Sunday, Ryan said that portion of the analysis was not accurate, arguing that the Affordable Care Act wouldn't be able to last 10 years. But he said the additional assistance was one of several House revisions to be discussed in advance of a vote, along with possible changes to help low-income people with tax credits and require able-bodied Medicaid recipients to meet work requirements.

"We believe we should have even more assistance. And that's one of the things we're looking at for that person in their 50s and 60s because they experience higher health care costs," the Wisconsin Republican said.

Separately, Ryan said he also expected the House to make changes to Trump's proposed budget, which calls for a boost in military spending and cuts in domestic programs.

"I would say this is the very, very beginning of the budget process," he said. "We are encouraged that we're seeing an increase in defense because we think our military has been hollowed out. But I will say that [the National Institutes of Health] is something that's particularly popular in Congress. ... So that is something that I think in Congress you'll see probably some changes."

Information for this article was contributed by Hope Yen of The Associated Press; by Jim Puzzanghera of the Los Angeles Times; by Ben Brody, Anna Edney, Mark Niquette and Shannon Pettypiece of Bloomberg News; and by Mike DeBonis of The Washington Post.

A Section on 03/20/2017

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  • TimberTopper
    March 20, 2017 at 4:17 a.m.

    This bill is DOA.

  • RBear
    March 20, 2017 at 7:16 a.m.

    Why not actually take this through a more deliberate process rather than try to rush it through Congress? Ryan already admits it's a bad bill and had Americans and some congressmen and women not pointed this out, he would have rammed it down our throats.
    Trump and his team don't have a clue about the bill and are just going along because that's about all he can do at this point. He made campaign promises that are in conflict with many points on the bill and is now starting his walkback because, quite frankly, for all his talk about having a plan he has none.
    This is a case of Republicans who are opposed to anything Obama did, but had no clue about how to solve the problems Obama tried to solve. It would have been better to have worked to improve the ACA rather than "repeal ... and replace." The later was added after Republicans realized they needed to actually come up with a plan instead of repealing only and throwing the marketplace into chaos.

  • mrcharles
    March 20, 2017 at 12:47 p.m.

    I would bring up that no where in the world is their free market capitalist health care that works, but i wont.
    I might say that there always has been a raise in premiums in health care and that it slowed under ACA, yet there is no need.
    I should say that others across the world come here to get the best health care in the world, so I will say that the very rich like Saudi princes come here with tubs of money who can afford the health care that the majority of USA inhabitants can only dream about. It is the size of the wallet that gets this star rated health care.
    I could say that in the developed countries that have versions of single payer health insurance, they are much happier with health care that USA. I will pray on that thought.
    I will say we did have an election in november, so why are the repugnants like a female dog chasing its tail? They hate the government being involved in a discretionary matter like health care, but as to your sex life with who and how and when, whether you smoke, bake brownies or otherwise ingest what the creator created for us [ sounds sacrilegious to question using what evidently a great deal of divine thought was put in in creating], what days and hours we can buy booze [ what if i want to do communion on a saturday night after the liquor stores are closed?] , you know personal choices that your friendly legislator will decide what is best for you by GOVERNMENTAL LAWS WITH A HAMMER TO SMASH YOU IF YOU STRAY FROM THE STRAIGHT AND NARROW PATH.

    In their defense for throwing the old under the bus, being one of them old, soon to discern the divinity or not of JC , it is true we are on our way out, and anything good we did for USA , WELL, what do we want a medal??..such as defending our country from imaginary dominoes , creating the worlds strongest military , making the worlds greatest country [ whoops, sorry Uncle Joe reminded me our military is not so great, our country is not so innocent, and sad to say our country has to be made great again by Orders of the super Patriot- though confusing during the Obama years the cons still told me we were the greatest country, then orange man said we need to become great and like lemmings they are in unison said Yeah!]

  • wildblueyonder
    March 20, 2017 at 1:10 p.m.

    Two things mrcharles needs badly are a dictionary and a Bible. He doesn't know anything about either! And like typical liberals his diatribes are verbose and senseless.

  • mrcharles
    March 20, 2017 at 2:25 p.m.

    gohog, I am always happy to learn, which bible do you suggest? Tell me which textual variants do you agree with as I have some trouble with several? Tell me where in the OT you find evidence of the trinity? Should we still cast into Exile those with skin diseases? Yet I must confess there is a great deal in some bibles [ have not read them all] that I do not understand, though as Mark Twain said pretty damn scared of the parts I do understand.

    I would appreciate to know how many wise men there were? Which time of day and which day your lord was crucified on? Why Joesph's wife once thought Jesus might be "mental" , forgetting her tip by an angel as to his divinity. The killing percentages of the Pharaoh's cattle by different plagues dont seem to add up- Please explain. Are you under powerful delusions so you will not believe what is needed for salvation & will go to the lake or pond of fire by disagreeing with me if I was a new prophet? Do you handle snakes? Me neither!

    I assume you voted for the most divisive POTUS in history , one who is presently helping the old meet their maker much quicker with his American Death Act?

  • wildblueyonder
    March 20, 2017 at 2:57 p.m.

    I suggest you read a MacArthur Study Bible. It contains the New Testament. No, the Bible never uses the term "trinity" but the trinity is the Father, the Son, and the Holy Spirit, three in One. Jesus was crucified on Friday and rose again on Sunday. Any part of a day was considered a full day, hence rising on the third day Scripture was fulfilled. What one must do is to believe in Christ as the Son of God who died for sinners, yes, even you, if you will accept Him as your only Savior. Read Acts 17:30-31.
    Yes, I voted for Trump, but the most divisive POTUS was Barack Hussein Obama whom I assume you wholeheartedly supported.

  • mrcharles
    March 20, 2017 at 3:53 p.m.

    gohog thank you for your input. we will make people mad on this side note, but why start today to worry.

    As i suspected a KJV ILK, with a pauline slant. As you know while literately KJV I consider tops, as to based on the best manuscripts most scholars agree it contains lesser qualified manuscripts. Just because it grew out of the textus recpetus, clearly the fact is that it has lost the firm support from the oldest extant Greek manuscripts, plus the earliest of the versions or translations, as well as the early Christian writers of the 2nd through 4th centuries. Age of manuscripts is probably the most objective factor in the process of textual criticism. When Westcott and Hort compiled their text, they employed the two oldest then-known manuscripts, Vaticanus and Sinaiticus, as their text base. Since then, a good number of manuscripts as old and in some cases a century or more older than these 2 manuscripts have been discovered. With a general uniformity, these early manuscripts have supported the Alexandrian text-type which the Westcott-Hort text presents.

    As to the crucifixion which you actually side step, please compare Mark's post Passover.. It was nine in the morning when they crucified him-vs John, the lamb of g-d based on the day the lambs were slaughtered, hence it was the day of "preparation" for the passover , the time about noon.

    I suggest a better version is Haprer Collin study bible, but of course a more learned NRSV version .

    The paulines have hard time until they do back flips then explaining the sheep & goats good works salvation. I guess you reject 1 John 5:7-8, though a good study bible will throw it out of the text and should not be preached on?

    so as to health care it is relevant bringing up the sheep and goats story of doing for fellow man.. there complainers!

  • wildblueyonder
    March 20, 2017 at 4:52 p.m.

    All that stuff is heretical.

  • mrcharles
    March 20, 2017 at 5:32 p.m.

    gohog, yes tertillium who came up with trinity was later deemed heretical, just like many who were making up this new religion as they went along - he also said oral sex was cannibalism l. But a mike masterson godnod came over me to my own trinity for you ,1. one of a trump supporter [ like you], 2,a person of G-d [remember to capitalize G] and 3. finally an expert on health care of the new American Death Act.
    A Tennessee woman who backs President Donald Trump credits God and the Republican health care bill — which hasn’t been voted into law — for her family’s dramatically lower insurance costs. Charla McComic’s son recently lost his job, and his health-insurance premium dropped from $567 per month to $88, which she described as “a blessing from God” and a gift from the new president, reported the Washington Post.

    The 52-year-old former first-grade teacher [ omg , thank you tennessee] thinks the change is due to tax credits that would be offered under the so-called “Trumpcare” law, if and when it’s approved by Congress and signed into law — but the price drop is actually a feature of former President Barack Obama’s Affordable Care Act.

    Workers who lose their jobs and employer-based health care coverage may enroll in Obamacare, which offers coverage based on income or possibly Medicaid for those with little or no income — like McComic’s son.

    McComic, who attended Trump’s rally this week in Nashville with four family members, told the Post she’s not worried that her 33-year-old son or 3-year-old granddaughter will lose their Medicaid coverage under the GOP plan.

    “So far, everything’s been positive, from what I can tell,” she told the newspaper. “I just hope that more and more people and children get covered under this new health-care plan.”

    McComic, who campaigned for Trump with some relatives by forming a motorcade and driving through their hometown shouting his name, said she’s never trusted a president as much as the real estate developer and former reality TV star.

    “We said: ‘Who else would we do this for, besides Trump?’” McComic said. “We agreed on the Lord. We would stand here for the Lord, but that’s about it.”

    Subtle but effective thinking for Trump supporters and the health laws!

  • TimberTopper
    March 20, 2017 at 6:32 p.m.

    gohog17, probably by now(and Hopefully) you have figured out that you have stepped into a bucket, and have not come out smelling like a rose. If not then your IQ is lower than I thought. You have been batted around like a cat playing with a mouse, and you are not the cat, in this case. However, he was very kind and considerate of your feelings, don't you think. Now that you've been played like a mouse, maybe that will increase your wisdom. Sometimes, the mousetrap catches the mouse. mrcharles, nice show!