Sen. Ted Cruz remains seated as President Donald Trump addresses a joint session of the Congress on Feb. 28. | Getty Republicans fight over what Trump meant on Obamacare

House Republican leaders were ebullient after President Donald Trump’s first address to Congress Tuesday night, convinced that their proposal to repeal and replace Obamacare had just gotten the presidential seal of approval.

Conservatives who abhor the GOP leadership plan saw just the opposite.


Congressional Republicans were yearning for some direction from Trump after spending weeks splintered on their Obamacare strategy. Trump did lay out details — using tax credits to help Americans purchase insurance, implementing tort reform, allowing for purchase of coverage across state lines — but he may have done little more than give a tiny nudge toward consensus on a health care plan, where Republicans still appear far apart on a deal.

House Majority Leader Kevin McCarthy (R-Calif.) confidently said “yes” when asked whether he saw Trump’s remarks on health care as an endorsement of the House GOP leadership plan — a proposal panned by conservatives as "Obamacare-lite."

“He said there should be tax credits, he said states should have more flexibility, he says we’ve got to [deal] with Medicaid and the transition, so what’s the Republican plan?” McCarthy said. “He just laid it out.”

House Majority Whip Steve Scalise (R-La.), the third-ranking House Republican, also argued that the details Trump laid out on Tuesday night were a “clear sign” that he was working “directly” with congressional Republicans on the leadership’s Obamacare proposal.

"We’ve laid out a lot of specifics,” Scalise said. “I think you saw the president embrace a lot of those key components tonight.”

Not so, insisted Rep. Mark Sanford (R-S.C.), a member of the House Freedom Caucus who has crafted a more conservative Obamacare replacement plan with Sen. Rand Paul (R-Ky.).

“We all hear what we want to hear in life,” Sanford said of McCarthy’s comments. “What I heard Trump say was something very similar to what Sen. Paul and I introduced. The leader must be hearing something a little different.”

Rep. Jim Jordan (R-Ohio) was equally adamant that Trump did not sign off on the leadership Obamacare proposal.

“No, I did not hear that. I heard repeal and replace, which is what we all campaigned on,” Jordan said.

Even before Trump finished his speech, conservatives were putting their heads together and agreeing that what Trump said about purchasing insurance through tax credits, or giving states flexibility on Medicaid, was no greenlight for House leadership.

In text messages to POLITICO, several conservative sources argued that they weren’t against health care tax credits to replace Obamacare but specifically advanced tax credits. Lower-income Americans can claim the latter right away based on income estimates for the coming year — even if they have no tax liability. Conservatives argue such system of sending a tax credit check will be rife with fraud and start “a new entitlement program.”

After the speech, they all argued that Trump didn’t say “advanceable” tax credits; nor did he detail other controversial parts of the House plan, such as the pay-for: curbing employer health care deductions.

“I didn’t hear ‘refundable tax credits.’ I didn’t hear ‘continued expansion of Medicaid.’ I didn’t hear of a quasi-Cadillac tax: the surcharge on employer packages,” Sanford said.

Sen. Ted Cruz (R-Texas), who along with Paul and Sen. Mike Lee (R-Utah) has prodded their leadership to repeal as much of Obamacare as possible, also said he didn’t hear Trump specifically back leadership’s plan. The trio of Senate conservatives plan to oppose any measure that provides refundable tax credits to help people purchase insurance — a plank of the leadership proposal.

“I don’t believe we heard any specific legislative endorsements,” Cruz told reporters. “The president was laying out principles — they are principles I agree with: that we should honor our word that we should repeal Obamacare; that we should reduce the cost of premiums; that we should expand choice; that we should empower patients.”

Still, other Republicans found plenty to like when it came to Trump’s health care comments. Trump called for flexibility for governors to “make sure no one is left out” when it comes to Medicaid. The issue of Obamacare’s Medicaid expansion has become yet another thorny one for the GOP, with Republican senators hailing from expansion states reticent to dismantle that provision.

“It’s huge for me,” said Sen. Shelley Moore Capito (R-W.Va.). She said during the speech, she sat in front of Sen. Rob Portman (R-Ohio) — both of their states took advantage of Obamacare’s Medicaid expansion — and once Trump mentioned that issue, “We’re like, yes! Here we go. So that was good.”

Conservatives, of course, say they didn’t interpret that to mean the expansion shouldn’t be rolled back.

For his part, Senate Majority Leader Mitch McConnell (R-Ky.) said Trump’s description of the health care plan he would like to see “helps” Republicans come together on Obamacare. Republicans in both chambers have been divided over the issue so far. McConnell is summoning his 52-member conference for a senators-only meeting Wednesday to try and forge a consensus on Obamacare.

“Obviously, we believe it has to be changed in a way consistent with many of the things the president recommended tonight,” McConnell said in an interview with CNN. “And we anticipate coming up with a proposal that the speaker, myself and president all agree on and then trying to sell to our own members, because we anticipate no Democratic support for replacing this monstrosity.”

Burgess Everett, Brent Griffiths and Heather Caygle contributed to this report.