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.
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"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.
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"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.
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