Melissa Nann Burke, and Jonathan Oosting

The Detroit News

Washington — Most Republicans in Michigan’s congressional delegation plan to support the GOP repeal of the Affordable Care Act when the House votes this week, although GOP Rep. Justin Amash of west Michigan will vote no.

The lawmaker who hasn’t confirmed his vote is Michigan’s senior Republican, Fred Upton of St. Joseph, who is leaning toward yes on the legislation after voting earlier this month to advance the initial bill in the House Energy and Commerce Committee.

President Donald Trump went to Capitol Hill Tuesday to meet with the 237 House Republicans. Trump and House Speaker Paul Ryan, R-Wisconsin, can afford to lose only 21 GOP votes to pass the legislation with 216 Republican votes.

Most Michigan Republican lawmakers don’t appear to be persuaded by Gov. Rick Snyder, who wrote this week to delegation members warning that the House GOP plan “will adversely impact” Michigan’s most vulnerable citizens and may lead to significant cost increases for seniors.

The Michigan delegation’s five Democrats are expected to vote against the bill, as are the other 188 House Democrats.

Upton has pushed back against some conservative demands, fighting efforts to shorten the transition period for beneficiaries of Medicaid, the health program for the poor. He was among members of the moderate Tuesday Group to meet with Trump at the White House on Tuesday.

“Fred remains committed to replacing Obamacare with health care solutions that provide more access and affordability for all Michiganders,” spokesman Tom Wilbur said. “As we move forward in this process, Fred looks forward to working with all of the governors to make improvements and provide more flexibility to the states.”

Amash, a member of the conservative House Freedom Caucus, says the group has more than 22 “no” votes — enough to prevent the legislation from passing.

“They haven’t changed the bill’s general framework. They don’t have the votes to pass it. They have seriously miscalculated,” he tweeted Monday after leaders released bill revisions in an effort to win over uncertain Republicans.

Amash says the bill lacks meaningful reforms, doesn’t do enough to reduce costs and breaks the Republican commitment to repeal Obamacare.

“While I’ve been in Congress, I can’t recall a more universally detested piece of legislation than the GOP health care bill,” he tweeted Monday.

Work requirements for some Medicaid recipients were among the bill’s revisions to win over conservatives, as well as the option for states to convert their Medicaid programs to block grants.

Dems welcome Snyder’s letters

Allowing states to implement work requirements for able-bodied Medicaid recipients was among a lenghty list of recommendations outlined last week by Snyder and Govs. John Kasich of Ohio, Brian Sandoval of Nevada and Asa Hutchinson of Arkansas — all Republicans.

As introduced, “the American Health Care Act shifts significant financial risk and cost from the federal government to states without providing sufficient flexibility to manage this additional responsibility,” Snyder told Michigan lawmakers in a series of individualized letters sent Tuesday.

Snyder’s office received the amended House legislation late Monday night and is reviewing it, spokeswoman Anna Heaton said.

“For once, I agree with Gov. Snyder’s views on the Republican health care bill — or as I call it, wealth care bill,” Rep. John Conyers, D-Detroit, said, highlighting data from Snyder that nearly half of all children in Michigan are covered by Medicaid.

“Gov. Snyder is right to be concerned about the additional costs this bad bill will shift to the state of Michigan.”

Rep. Debbie Dingell, D-Dearborn, said she is particularly concerned about how the bill could cause seniors’ premiums to spike and for the 24 million Americans who risk losing their coverage in the next decade, according to an analysis by the nonpartisan Congressional Budget Office.

“The bill’s amendment does nothing to change the fact that a factory worker would pay more for their health care under the Republican proposal, so that the wealthiest families can each receive a $7 million tax break,” she said.

But David Russell, spokesman for Rep. John Moolenaar, R-Midland, said the legislation’s Medicaid reforms gives states enough flexibility to serve their most vulnerable populations.

“With $20 trillion in national debt, state governments need to stop looking at federal funding as free money,” Moolenaar said. “Those taxpayer dollars come out of the pockets of hardworking Michigan residents.”

New state flexibility lauded

Rep. Bill Huizenga, R-Zeeland, said the letter from Snyder was the first official communication he’s received from the governor on the health care legislation.

He said the newly added block grant option would give states more flexibility for their Medicaid programs, cutting out some of the bureaucratic processes.

“I don’t know how much more flexible you can get than that. It needs to be about results, not about processes necessarily,” Huizenga said at the U.S. Capitol.

One of his concerns was how the bill would affect seniors, whose premiums are expected to increase. The revised bill addressed the issue by setting aside money for tax credits for seniors.

GOP Reps. Tim Walberg of Tipton and Mike Bishop of Rochester each voted in committee to advance the legislation to the full House.

Through a spokesman, Walberg noted that the bill is the first of a three-pronged reform effort and that Health and Human Services Secretary Tom Price has written to state governors affirming his agency’s intent to take administrative action and work with states to improve the Medicaid program.

In response to Snyder’s concerns, Bishop stressed that the House GOP plan ensures states may maintain coverage for residents who are currently enrolled in Medicaid expansion for as long as they remain enrolled in the program.

“Medicaid is not on sustainable financial footing, and it cannot stay intact if we continue to kick the can down the road,” Bishop said.

“Our new amendment, which is not reflected in the governor’s letter, goes even further to provide a more substantial reimbursement for older and disabled Medicaid recipients.”

Freshman Rep. Paul Mitchell, R-Dryden, approves of the amended bill and intends to vote for it.

“This is a rescue mission; allowing the system to continue to collapse will result in even fewer choices and, eventually, a lack of access to care,” Mitchell said.

Rep. Jack Bergman, R-Watersmeet, last week voted in the House Budget Committee to advance the bill to the full House for consideration. Bergman told Interlochen Public Radio Friday that he supports the bill.

“By and large, the bill is our next essential step to make sure we deal with the reality that Obamacare has failed,” Bergman said.

In a Tuesday statement, the freshman lawmaker reiterated that the GOP replacement plan is better than current law.

“Obamacare is on the edge of collapse, and instead of standing idly by, Republicans are doing something about it,” Bergman said. “We’ve promised Americans not just coverage, but quality care. This patient-centered, choice-based plan is about keeping that promise.”

mburke@detroitnews.com

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