Eliza Collins, and Erin Kelly

USA TODAY

WASHINGTON — The new Republican legislation to repeal and replace Obamacare was welcomed Tuesday with a torrent of criticism from conservatives in Congress and outside advocacy groups, which could imperil its chances of passage on the expedited schedule congressional leaders have set out.

But House Speaker Paul Ryan, R-Wis., was undeterred. "We’ll have 218 when this thing comes to the floor, I guarantee it,” Ryan said, referring to the number of votes required for legislation to pass through the House.

Key conservative Republicans in the House and Senate attacked the bill for creating what they said was basically a new entitlement program and for leaving too much of Obamacare and its taxes in place.

"This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction," said Sen. Mike Lee, R-Utah.

Lee and Sen. Rand Paul, R-Ky., joined a Tuesday press conference of House conservatives to denounce the bill offered by Republican leadership. Rep. Mark Meadows, R-N.C., and other members of the House Freedom Caucus — a bloc of about 40 of the most fiscally conservative House Republicans — took turns raising concerns about the bill, and Rep. Jim Jordan, R-Ohio, said he will offer an alternative bill Wednesday that would simply repeal the Affordable Care Act.

“In simple terms, I don’t think we promised the voters we’d repeal it, but we’re gonna keep taxes in place. We’re gonna repeal it, but we’re gonna keep Medicaid expansion in place for four years and we’re gonna repeal it, but start a new entitlement with a fancy name of ‘advanceable refundable tax credits,' " Jordan told USA TODAY. "I don't believe this is actually going to bring down the cost of treatment, I don't know that this is going to bring back affordable insurance," he continued.

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Influential conservative advocacy groups urged their allies in Congress to reject the bill.

Michael A. Needham, CEO of Heritage Action, the advocacy arm of the conservative think tank the Heritage Foundation, issued a blistering review of the draft Tuesday morning: "In many ways, the House Republican proposal released last night not only accepts the flawed progressive premises of Obamacare but expands upon them."

Needham echoed conservative calls for a full repeal and then a conversation about how to move forward on a replacement. The Heritage Foundation has been one of the most influential groups helping conservative lawmakers set their agenda in Congress.

The conservative Club for Growth and the libertarian-minded FreedomWorks group also came out against the GOP bill on Tuesday, along with the Tea Party Patriots.

“They all ran as conservative Republicans and said 'we’re going to get rid of Obamacare,' they need to do it. And then instead of building Ryancare, that’s Obamacare lite, they need to build a Republican principled-bill and then they should all vote for it,” Club for Growth President David McIntosh told USA TODAY. He added if they weren't able to change the bill, his group would put significant resources behind making sure that voters knew which lawmakers weren't backing a conservative plan.

Vice President Pence told MSNBC on Tuesday that he believes conservative opposition can be mollified as the bill moves through Congress.

"We are very early in the legislative process," Pence said. "As the president has made very clear, we are open to working with members of the House and Senate on ways we can improve the bill, but we believe the American Health Care Act is the right framework for replacing Obamacare, and in the days ahead, the president and I both look forward to making that case to members of Congress and to the American people."

Meadows told reporters he had met with Pence and was confident that the legislation would eventually have a conservative stamp.

“The bill that was introduced last night is still open for negotiation,” Meadows said. “We took that as very encouraging news.”

President Trump tweeted Tuesday morning that the bill had been released "for negotiation," but Ryan suggested later in the day there was not much room to make changes.

"It’s not that this is open for negotiation," Ryan said. Instead, he said critics will come to understand that the repeal bill is just the first part of a three-phase process for replacing Obamacare.



The first phase is the passing the bill using a budget procedure that allows for a simple majority to pass the Senate rather than the usual 60 votes. That means Republicans could pass it with no Democratic support.



The second phase would be new rules that Health and Human Services Secretary Tom Price will produce to deregulate the insurance marketplace. And the third phase would be additional replacement bills that can’t be pushed through using the streamlined budget procedure, like allowing insurers to sell across state lines and capping medical liability. Those bills will require some Democratic support in the Senate.

"We're going to do something that is great," Trump said during a meeting with House Republicans who will be in charge of rounding up votes for a health care bill. “It's a complicated process, but actually it's very simple," he added. "It's called good health care."

The House Ways and Means Committee is scheduled to begin voting on the bill Wednesday morning; the Energy and Commerce Committee will also take up the bill this week.

Senate Majority Leader Mitch McConnell, R-Ky., said he still believes Congress can pass the bill before lawmakers depart for their April recess.

During an appearance in the White House briefing room Tuesday, Price — who was until a month ago a leading conservative in the House — said the House plan includes the four principles the administration seeks: affordability, accessibility, encouragement of innovation and empowering of patients.

"The goal of all of this is patient-centered health care," Price said. He said the White House will work with critics to address their concerns with the bill.

In the Senate, where Republicans hold a slim majority of 52 seats, GOP leaders are also in danger of losing the support of moderate Republican senators from states that expanded their Medicaid programs for low-income residents with help from the federal government as part of Obamacare. Under the proposed American Health Care Act, people who live in the states that expanded Medicaid would be able to enroll in the program for just three more years, until Jan. 1, 2020.

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Just ahead of the public release of the bill, four GOP senators sent a letter to McConnell raising concerns based of a previous draft that the a repeal would harm “the core of the health care safety net for individuals across the country” by scaling back the Medicaid expansion which was put in place under Obamacare.

“We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states," wrote Sens. Rob Portman, R-Ohio, Shelley Moore Capito, R-W.Va., Cory Gardner, R-Colo., and Lisa Murkowski, R-Alaska.

Portman said Tuesday he was satisfied with how the revised House GOP plan dealt with Medicaid expansion. But he said he is still reviewing other elements of the bill and is not ready to take a position on it yet.

“I wanted to be sure those people who were on expanded Medicaid in Ohio were not left behind, that they were able to have continued access to coverage. And that particular issue has been addressed,” Portman said. “But there are many other issues,” including how the tax credits will work and what kind of flexibility state governments will have to improve health insurance coverage."

Missouri Republican Sen. Roy Blunt was not confident about the bill's ability to pass in its current form Tuesday. He told local radio station KMBZ that "it may not be a plan that gets a majority votes and lets us move on."

"I think the nucleus of the plan is clearly there and the president says it's negotiable and so do House members," he continued in an interview that was first reported by CNN. "So, I'll be interested to be a part of that negotiation as we work toward a majority in the House and Senate that puts a bill on the president's desk."



