Iowa Rep. Steve King said he is concerned that the Republican plan would “establish that your health insurance policy is an entitlement.” | AP Photo House Republicans still apart on Obamacare repeal-replace

House Republicans emerged from a critical pre-recess meeting Thursday still sharply divided over how to repeal and replace Obamacare, including how to overhaul Medicaid.

GOP leaders presented a menu of options for a health care alternative at the closed-door session, according to lawmakers in the room. But the lack of consensus was apparent as members left. In addition to questions over Medicaid, conservatives took issue with proposals to replace the health care law's subsidies with tax credits to help consumers buy insurance. Many members also were lukewarm to ideas floated to fund a legislative package.


“We’re looking at a wide range of options,” said House Ways and Means Chairman Kevin Brady.

House Speaker Paul Ryan on Thursday told reporters the House will find a solution to “accommodate” states that did expand Medicaid under Obamacare and those that did not — a chief concern of Republicans from states that expanded their programs and could see huge cuts if the law is repealed.

Committee chairmen are working with governors to find a solution that gives more control to states and do it “in a way that doesn’t disadvantage either of the two sides of that coin,” Ryan said.

The continued discord seven weeks into the new Congress brought into high relief Republicans’ struggle to get on the same page to fulfill their most basic campaign pledge — a task that is turning out to be more complicated than they imagined. At town halls across the nation, lawmakers are getting grilled by progressives and others irate at their efforts to dismantle President Barack Obama’s signature health care law. Leadership gave members a 19-page policy outline ahead of next week's recess.

Newly confirmed H ealth and H uman S ervices Secretary Tom Price told lawmakers at Thursday's meeting that President Donald Trump “is all in on” repealing and replacing Obamacare at the same time. Earlier this week, the conservative House Freedom Caucus called on Republicans to repeal the law first and work on a replacement later.

"Let's not miss this opportunity,” Price said, according to a source in the room. “Let's go shoulder to shoulder, arm to arm.”

Republicans appear to be in agreement on the broad strokes of a plan: Use a 2015 Obamacare repeal bill as a start , then pack in as much replacement policy as possible, including creation of high-risk pools, health savings accounts, tax credit assistance and significant Medicaid changes.

But the details are far from clear and , in fact, cracks in the outline have emerged. Some Republicans want to keep some of the Obamacare taxes in order to pay for the new plan. Lawmakers from states that expanded Medicaid under Obamacare don’t want to roll back the expansion because it could hurt their state’s coffers.

They want to give states flexibility under Medicaid but don’t have agreement on how to structure that.

“They don’t have any real numbers yet,” said Rep. Fred Upton (R-Mich.), former chairman of the House Energy and Commerce Committee.

Despite the lack of agreement, Republicans are still expected to move forward with markups in committees the week of Feb. 28. Ryan tweeted Thursday that the bill would be released after President s Day.

House Rules Chairman Pete Sessions (R-Texas) said he was supportive of the overall plan but lukewarm about one proposed pay-for — in particular , a pitch to curb the tax credit employers get to provide insurance in order to pay for the GOP alternative.

“Capping the exclusion to me is like a Cadillac tax,” he said, referring to Obamacare’s tax on high-cost health insurance plans.

Sessions noted that leadership didn’t get into costs, so even though he likes the plan generally, the devil is in the details.

“It was sans money; they don’t have the [Congressional Budget Office] scores,” he said. “There were many things in there that are very consistent … but once again, they did not overlay the money , and that’s the big question.”

Republican Study Committee Chairman Mark Walker (R-S.C.) said conservatives’ top “hang-up” is “the cost of those tax credits,” which has yet to be released. Conservatives worry the refundable tax credit would require a tax increase on others to sustain them down the road, and they’re predicting high fraud rates would plague the program.

Instead, some have floated a tax deduction. But that wouldn’t help the poorest Americans, who need financial help to buy insurance and don’t usually pay taxes.

“What we don’t want is … a fourth column of entitlements; we don’t want this to be long term and become another one of those situations,” Walker said.

Other conservatives echoed the concerns. Rep. Steve King (R-Iowa) said he is worried that the Republican plan would “establish that your health insurance policy is an entitlement.”

Some conservatives left the meeting frustrated at the slow pace of repeal.

Rep. Louie Gohmert (R-Texas) said all he heard was “basically a 40-minute explanation of how it’s being improved, so that concerns me.”

Asked whether he felt Congress is moving closer to a plan that conservatives could support, he added, “We are being told we’re closer.”