Republican Hard-Liners Oppose Health Care Plan Led By Paul Ryan

Some conservative members of Congress and activists who bedeviled GOP leadership during the Obama administration are back again in opposition to the health care plan led by House Speaker Paul Ryan.

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Now to Congress where a group of conservatives is trying to block the Republican leaders' plan to repeal and replace the Affordable Care Act. Now, this right-wing block has challenged party leadership before, frequently. These days, though, it risks crossing the president. As NPR congressional correspondent Susan Davis reports, this familiar confrontation could derail his attempts to deliver on a signature campaign pledge.

SUSAN DAVIS, BYLINE: House Speaker Paul Ryan sounded a little annoyed today at the suggestion that some of his Republican colleagues don't like their emerging health care plan. There's no surprises here, Ryan says. It's exactly what Republicans campaigned on.

PAUL RYAN: We told America, here's our vision for how we replace Obamacare after we repeal Obamacare. That's the bill we're working on right now. That's the bill we're working on with the Trump administration.

DAVIS: Republicans have not released a bill, but the core of the proposal under discussion would repeal the individual mandate and replace it with a refundable tax credit for individuals to buy insurance. And that's where the problems start.

RAND PAUL: Conservatives aren't voting for that. So I think we should just brush that off the table. The whole thing coming out of the House - just completely start over.

DAVIS: That's Kentucky Republican Senator Rand Paul. He's part of a trio of senators that includes Ted Cruz of Texas and Mike Lee of Utah who are threatening to take down the legislation in the Senate unless major changes are made. They argue that refundable tax credits are just another entitlement program. That means more federal spending. For Ted Cruz, it's a nonstarter.

TED CRUZ: We should not focus on ideas that divide us and pull us apart. We don't have a big enough majority to be divided. We have to be united.

DAVIS: Paul and South Carolina Congressman Mark Sanford have a competing health care proposal that also includes a tax credit, but it's not refundable. Their plan would let individuals pay less in taxes but not get any additional money back from the government. It may sound like a small difference but not to conservatives like Sanford.

MARK SANFORD: And there is a world of divide, and I think this is a divide that's strong within the conference.

DAVIS: Sanford's a member of the House Freedom Caucus, that same group of conservatives that has repeatedly clashed with party leaders over the agenda. With narrow GOP majorities in both chambers, these conservatives have the power to block a health care bill if they hold together. The speaker's office says the White House is on their side, and most Republicans believe the party will ultimately rally behind whatever President Trump supports. Here's Georgia Senator David Perdue.

DAVID PERDUE: We're going to have a position, but you know, we're going to have a position that the White House will sign. And when that's - when they - when the White House weighs in on that, I think you'll see us all line up because we know how important this is to get this fixed.

DAVIS: Republicans like North Carolina congressman Mark Walker say conservatives are confronting the new reality of governing. It's a lot harder to oppose a Republican president.

MARK WALKER: That with a Republican administration, there has to be some consideration that there is some leniency as far as, ultimately, how do we partner; how do we move forward as opposed to just putting up a roadblock?

DAVIS: But conservative activists don't see it that way. Adam Brandon is the president of FreedomWorks, a tea party-aligned group that wants to see Congress pass a bill more closely aligned with Rand Paul than Paul Ryan. FreedomWorks is preparing a lobbying push this month to try to move Congress in their direction. Brandon believes conservatives will oppose a health care plan if it's not conservative enough even if Trump supports it.

ADAM BRANDON: So most of these folks that I just mentioned in the House Freedom Caucus would rather lose if - than vote for a brand new entitlement that in their heart of hearts is not the answer.

DAVIS: House leaders are moving forward, which means conservatives have a decision to make. Here's Mark Walker again.

WALKER: I think it's really coming down to the next 10 to 14 days to be able to say, OK, either you're in or you're out.

DAVIS: A bill could be unveiled as soon as next week. Susan Davis, NPR News, the Capitol.

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