Dozens of conservative lawmakers in the House’s Republican Study Committee huddled behind closed doors in the basement of the Capitol Wednesday with Vice President Mike Pence to discuss their imperiled Obamacare repeal bill—which has been lambasted by moderates and conservatives alike.

When the lawmakers emerged, they expressed confidence that the White House supports the changes they are demanding: freezing the Medicaid expansion in 2018 instead of 2020, and imposing a work requirement on low-income Americans receiving Medicaid.

“Ultimately, we were told today that we should be hopeful as far as having some of this incorporated into the bill,” RSC chairman Rep. Mark Walker (R-NC) (pictured) told reporters. “We’re as hopeful as we’ve ever been.”

Even as hardline conservatives, moderate Republicans, and Trump loyalists continue to come out against the bill, Walker said the changes to its Medicaid provisions would bring his 170-member group on board. The RSC includes many of the the most conservative Republicans in the House.

“The RSC in general is very close to signing off,” he said. “Our ultimate goal is a unanimous vote of support.”

Walker and several other members of the RSC emphasized their desire to amend the bill—either in the Rules Committee or on the House floor—to make any able-bodied adult currently enrolled in Medicaid have to prove employment in order to qualify for health insurance.

“We’re trying to make sure we’re weeding out those with upward mobility,” Walker told reporters. “It’s very crucial that this has some teeth to it, because what you don’t want is for the money to be rationed out among a larger amount of people.”

Citing the example of his own brother, who is blind, Walker said throwing people off Medicaid who are able to work but don’t leaves the program with more funding “to take care of the aged and disabled.”

Rep. Barry Loudermilk (R-GA) was one of several members to voice support for the work requirement. “If we can add that, I believe it will help pass the bill and make Americans more comfortable with it,” he said.

A study released in 2016 by the Center for Budget and Policy Priorities found that most Medicaid recipients who are physically able to work already do so, and imposing a work requirement for enrollees would do nothing to increase the work force in the long term. “Its main effect likely would be the loss of health coverage for substantial numbers of people who are unable to work or face major barriers to finding and retaining employment,” the study found.

The Kaiser Family Foundation estimates that only 27 percent of Medicaid recipients are adults without disabilities, and 60 percent of that group are already working. Many of those not employed care for a family member full-time, have a criminal record, live in an area without job opportunities, or face other “major impediments” to employment.

This week, the Trump administration announced it will allow individual states, if they wish, to impose some form of a work requirement on their Medicaid recipients. The members of the Republican Study Committee hope to make this policy mandatory, and national.

“A work requirement would gather support from a lot of conservatives,” Rep. Phil Roe (R-TN) told reporters.

Rep. Glen Grothman (R-WI) added that it “wouldn’t shock” him if the provision was soon added to the House bill.

As is, the House bill would cut nearly $900 billion dollars from Medicaid and drop more than 14 million people from its rolls over 10 years, according to the Congressional Budget Office. If conservatives win the concessions of imposing a work requirement and speeding the conversion of the program into block grants handed out to state, those numbers could increase substantially.



VP Mike Pence met with the Republican Study Committee on Wednesday.

As House Republicans tout their progress pulling the health care repeal bill further to the right, they risk alienating their moderate colleagues both in the House and the Senate, who are fighting for provisions that offer more support to low-income Americans.

RSC members admitted to the gathered reporters on Wednesday that they are walking a fine line with their conservative demands.

“It’s a chess game,” said Rep. Mark Wayne Mullin (R-OK). “You win some, you lose others.”

“We have to find that sweet spot,” stressed Loudermilk. “But I think there will be well over 218 [votes in the House] if we can make a few little changes.”

Walker said he believes moderate Republicans in the House, particularly those in the Tuesday Group, can be coaxed on board with their proposals. He added that while his colleagues originally wanted to push for more extreme changes to the bill, such as gutting the Essential Health Benefits requirement that insurance plans cover a set of basic services, including contraception and maternity care, but decided to focus on “easier and quicker” Medicaid reforms first.

Loudermilk also admitted that that he will not get his full wish list in this bill.

“America is not ready for the health care reform I want, which is to get this city totally out of the health care business altogether,” he told reporters. “Because you even have conservatives out there asking us to do things like arrange insurance sales across state lines, cover pre-existing conditions, and keep children on their parents’ plan until they’re 26. So even conservatives want some federal interventions. But we still have to shift the needle in the right direction.”

The CBO reported on Monday the even without the RSC’s demanded changes, the House bill would cause 24 million people to lose their insurance over the next 10 years. Efforts to limit who qualifies for Medicaid could boot many more from the program. But RSC members largely dismissed these concerns, echoing the White House’s argument that the insurance people currently have through Obamacare is “worthless.”

“Having access to insurance doesn’t mean having access to care,” Loudermilk said. “People have insurance right now and it’s not doing them any good.”