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House Speaker Paul Ryan speaks to reporters after a meeting with President Trump, who came to Capitol Hill to rally GOP lawmakers behind the Republican health care overhaul. J. Scott Applewhite/AP hide caption

House Speaker Paul Ryan speaks to reporters after a meeting with President Trump, who came to Capitol Hill to rally GOP lawmakers behind the Republican health care overhaul.

Republicans will be tested today on the strength of party unity in the Trump era and their party's ability to deliver on the promises they've made to the voters that sent them here.

"This is our chance and this is our moment. It's a big moment," House Speaker Paul Ryan told reporters earlier this week. "And I think our members are beginning to appreciate just what kind of a 'rendezvous with destiny' we have right here."

The moment is particularly defining for Ryan, the reluctant speaker who is facing the toughest legislative battle of his nearly 20-year congressional career. "One of the reasons I don't want this bill to fail is I don't want Paul to fail," said Rep. Mike Simpson, R-Idaho, an ally of the speaker who supports the bill.

The speaker has put the full weight of his office behind passing legislation that goes much further to repeal and replace key pillars of Obamacare, to remake Medicaid into a block grant program that caps federal spending. The entitlement program predominantly helps the poor and currently has an open-ended funding stream.

It's the kind of conservative reform that Ryan has jokingly said he's dreamed about since his keg party days, but it might not be enough even with Republicans in control of both chambers of Congress and the White House.

The House Freedom Caucus, a bloc of about 30 hard-line conservatives, maintain going in to today's scheduled vote that they have enough members on their side to defeat the bill. Their opposition has not softened, despite continued efforts by President Trump, Vice President Pence and their senior White House aides to grant concessions and cajole lawmakers from districts Trump won by big margins last November.

"We're being asked to sign a blank check and hope it works out," said Rep. Scott Perry, R-Pa., a member of the Freedom Caucus, "And in the past that hasn't worked out real well for this process, so I think we're right to be skeptical."

Perry was one of about 25 Freedom Caucus members who huddled with Vice President Mike Pence and White House adviser Kellyanne Conway on Wednesday. It didn't change his vote. Conservatives like Perry want the bill to go even further to repeal President Obama's health care law. Specifically, these conservatives want assurances the final bill would ultimately repeal the essential health benefits included in the Affordable Care Act, which cover 10 categories of health services insurance plans must cover, including prescription drugs and prenatal care.

"We want free market competition and how can you have free market competition when the government is mandating what's going to be included?" Perry said. Conservatives argue that eliminating the essential health benefits will allow insurance companies to offer cheaper insurance plans with more tailored coverage. Opponents say it will only increase out-of-pocket costs for consumers.

Conservatives also received some political cover from outside conservative activist groups like Heritage Action and FreedomWorks, which came out in opposition to the bill.

The network of political action groups funded by Charles and David Koch, wealthy libertarian-minded donors who have not supported Trump, are putting money behind their opposition to the bill. Two Koch-funded groups, Americans For Prosperity and Freedom Partners, announced last night they would establish a seven-figure fund "to stand by principled lawmakers who keep their promise of fully repealing Obamacare by opposing the American Health Care Act (AHCA) unless there are significant changes." It amounts to a promise of protection for members who might fear a primary challenge for breaking with Trump.

As the day unfolded yesterday, it became clear that conservatives were not the only weak link in the vote count. With every new "yes" vote announced, a "no" vote would appear. Reps. Lou Barletta of Pennsylvania and Steve King of Iowa announced they would support the bill on Wednesday, but their support was offset by fresh opposition from lawmakers including Don Young of Alaska, David Young of Iowa, and Frank LoBiondo of New Jersey.

The trio of opponents are mainstream Republicans, the kind of rank-and-file members party leaders can usually rely on to pass their agenda. But the policy in the GOP bill, the American Health Care Act, would disproportionately affect older, poorer Americans the very constituents who make up many GOP lawmakers base of support back home.

For instance, LoBiondo said in a statement that his South Jersey district and its retirees would suffer under AHCA. "Three South Jersey counties have more than 30% of their residents receiving Medicaid assistance. Medical professionalsour hospitals, doctors, nurses are opposed," he said.

The speaker focused on more moderate members of the GOP, working members during House votes on Wednesday and holding one-on-one meetings in his office throughout the day.

"If you don't recognize how much is on the line, you haven't been paying attention," said Rep. Tom Cole, R-Okla. He supports the bill and, like many lawmakers, remained optimistic that the votes would come together to pass it. Cole even suggested they might have to win the vote on the floor. "You never know about these things until you actually get to the vote," he said.

With five vacancies in the 435-member House, Republicans can lose 21 votes and still pass the bill. Every Democrat is expected to vote against it. House Republicans enjoy one of their largest majorities in decades, so the 21-vote cushion is much larger than past GOP-controlled congresses have enjoyed.

Cole said most Republicans were aware of the importance of this vote: "It's a very consequential vote. It really is: 'Can you govern or can't you?' "

For their part, Democrats are unified against the bill, which undoes President Obama's signature domestic achievement. Former Vice President Biden returned to Washington to voice his opposition to the bill at a rally outside the U.S. Capitol.

"Look, folks, here's the deal: When you cut to the chase, we're talking about eliminating close to a $1 trillion in benefits that go to people to be able to meet the commitment we made that health care is a right, and we're transferring all of that to the wealthy," Biden said. "That's what this is all about, it's about a transfer tax, basically. Eliminating the Affordable Care Act means eliminating an awful lot of things that people need."

If the House approves the bill on Thursday, the thrill of victory will be short-lived. The bill still needs to pass the Senate, and it faces a new round of opposition and legislative hurdles in that chamber. The bill then would need to back to the House again to approve any Senate-passed changes before it could go to Trump's desk.

Read more here:
In Final Hours, GOP Leaders Scramble For Votes On Bill To Gut 'Obamacare' - NPR

Members of the conservative congressional Freedom Caucus vow to defeat the GOP health care bill. (Inform)

The GOP House health care plan has lots of moving parts, but dont fret. We at PolitiFact have been analyzing the legislation since its release.

Heres what you need to know.

The first thing to keep in mind is that the GOP bill, the American Health Care Act, actually retains some important parts of the Affordable Care Act, or Obamacare.

Staying in place are provisions that prohibit insurance companies from denying coverage for a pre-existing health problem, like cancer, and a provision that prohibits insurance companies from raising premiums based on a persons health. Kids can continue to stay on their parents health insurance until they turn 26. Insurance marketplaces where people browse for coverage stay in place. And regarding Medicare, Republicans retain long-range spending limits that they once railed against.

The Republican bill also continues to subsidize premiums to make insurance more affordable, but the size of those subsidies and who gets them changes significantly. The Congressional Budget Office said the average subsidy would be about 60 percent of what people would get under Obamacare. This part of the GOP plan delivers one of the top two spending reduction moves in the overall bill, the CBO said.

To help people who buy insurance on their own, the American Health Care Act uses refundable tax credits based on the following schedule:

Under age 30: $2,000

Between 30 and 39: $2,500

Between 40 and 49: $3,000

Between 50 and 59: $3,500

Over age 60: $4,000

No household would get more than $14,000 worth of credits and the credits taper off for single filers making over $75,000 and joint filers making over $150,000.

The GOP bill makes one other key change that affects premiums. It would allow insurance companies to charge older people up to five times more than younger ones. Under Obamacare, the limit is three times more. Combine that with the new subsidy approach and, by the CBOs estimate, the impact on older, poorer Americans would be large.

A 64-year-old making $26,500 would be responsible for $14,600 in premiums under the American Health Care Act. With the Affordable Care Act, the same person would pay $1,700. A 40-year-old making the same amount would also pay more, but his or her bill would go from the same $1,700 to $2,400 under the GOP bill.

Republicans counter that the CBO analysis fails to take into account future GOP plans to change the health care system through overhauling regulations and additional legislation.

Aside from premiums, Obamacare offered cost-sharing to defray the out-of-pocket expenses, such as deductibles and co-pays, for people making between 100 and 250 percent of federal poverty. The American Health Care Act eliminates that additional assistance.

Another big change in the American Health Care Act is the end of the insurance mandate. Today, nearly everyone must buy insurance or face a tax penalty. The Republicans do away with that, although their bill would allow insurance companies to charge a one-year 30 percent premium fee for those who had failed to buy insurance when they could have.

Big changes for Medicaid

The bills Medicaid provisions deliver the other large basket of savings for the federal budget. One of the key balancing acts for Republicans involves the 31 states that chose to expand Medicaid under Obamacare to include people making up to to 138 percent of federal poverty. The standard cut off is 100 percent.

Part of the deal was Washington would cover at least 90 percent of the costs for people in the expansion group. The typical federal match is more in the 50 to 75 percent range. The American Health Care Act takes several steps to eliminate the higher rate.

States that havent expanded Medicaid by March 1, 2017, would not be able to get the more generous federal match if they expand Medicaid eligibility. Those that had expanded would see the higher match end as of January 2020, with one exception: The bigger federal share would continue for anyone in the expansion group as of December 2019, so long as that person never had a break in eligibility longer than one month.

2020 marks another game changer in Medicaid. That year federal payment to states would shift to a per person basis with limits on the growth in those payments going forward. Alternatively, states would have the option to shift to a block grant approach, but just for the non-expansion participants. A block is what it sounds like -- a lump sum payment that is independent of the number of people in the Medicaid program or the cost of their care. Either way, the changes put more on the shoulders of the states, either to control costs or raise taxes.

Lastly, states would have the option to impose a Medicaid work requirement for anyone who isnt pregnant, disabled or elderly.

Tax changes

At the same time the House bill cuts spending, it also cuts revenue for the federal government. Obamacare helped pay to cover the poor and working poor by taxing wealthier Americans, insurance companies and medical device makers. The Republican bill does away with all of those as of January 2017.

Taken together, the most valuable of the tax cuts are the ones for individual taxpayers making over $200,000 and couples making over $250,000. They have been paying more in Medicare taxes and another charge called the net-investment tax. The combined total tax reduction is more than $275 billion over a 10-year period, according to the CBO.

The American Health Care Act also increases tax incentives for Health Savings Accounts and makes more health care expenses tax deductible.

Other important elements

The American Health Care Act creates a $100 billion fund over nine years to help states cover a range of contingencies, including caring for the most expensive patients, lowering the premiums and out-of-pocket costs for people 50 to 64 years old and other health care related expenses.

The bill also aims to prevent government funding for abortion. It bans all money for Planned Parenthood and blocks the use of tax credits to pay for insurance plans that include abortion or abortion services.

For states that choose the Medicaid block grant option, family planning would no longer be a mandatory covered service.

For anyone who wants all the details, we recommend the side-by-side comparison work of the Kaiser Family Foundation.

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A cheat sheet

What's in the American Health Care Act?

Wednesday, March 22, 2017

03/22/2017

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PolitiFact's guide to the Republican health care bill - PolitiFact

Hawaii Rep. Beth Fukumoto talks to reporters about why she's leaving the Republican Party on March 22, 2017, in Honolulu. Cathy BussewitzAP

(HONOLULU) A Hawaii lawmaker who says she was pressured to give up her leadership post at the statehouse after criticizing President Donald Trump resigned Wednesday from the Republican Party.

Rep. Beth Fukumoto said members of the GOP refused to oppose racism and sexism including a suggestion by Trump to create a Muslim registry during his campaign.

"As a Japanese-American whose grandparents had to destroy all of their Japanese artifacts and items and bury them in the backyard to avoid getting taken and interned, how could I not have said anything?" Fukumoto asked. "And how could my party have not said anything?"

Fukumoto was voted out of her post as House Minority Leader in February after calling Trump a bully in a speech at the Women's March in Honolulu, saying many of his remarks were racist and sexist and had no place in the Republican Party.

Since then, she sought feedback from her constituents about leaving the GOP and said three-quarters of the more than 470 letters she received supported the move.

She said she agrees with many Democratic positions on affordable housing and equitable taxes, and hopes to join that party.

Hawaii Democratic Party leader Tim Vandeveer said Democrats will give Fukumoto a fair shake, but some members are concerned about her past voting record on civil rights and women's issues.

"Changing political parties is not like changing jackets, just because the weather's better on our side of the street," Vandeveer said.

Fukumoto voted against same-sex marriage when it came before the Legislature in 2013. She said Wednesday she voted that way to represent the majority of her constituents, but if she was voting on her own, she would have voted yes.

On reproductive rights, Fukumoto said she does not believe in abortion in all three trimesters but does not want to rescind individuals' rights once they have been granted.

"We have choice laws in Hawaii and I'm not looking to repeal those laws," she said.

Members of the Democratic Party on Oahu will ultimately decide whether to accept Fukumoto, but the process could take months, Vandeveer said.

Fukumoto said she's received letters of encouragement from Democrats and Republicans in nearly every state.

Democratic U.S. Sen. Brian Schatz welcomed her to the party in a tweet, saying he's proud of her courage.

Republican state Rep. Cynthia Thielen, a Fukumoto ally who voted against removing her from leadership, said, "the tiny party's brand is further weakened and its relevance to the wider, diverse constituency looks bleak."

With Fukumoto's departure, Hawaii has just five Republican state representatives and no Republican state senators.

Hawaii Republican Party Chairman Fritz Rohlfing declined to immediately comment because he had not yet reviewed Fukumoto's resignation letter.

Read more:
Hawaii Republican Resigns From Party After Criticizing Trump - TIME

NPR

House Set To Vote On Republican Health Care Bill NPR A vote on the Republican health care plan in the House is scheduled for Thursday. Some very conservative Republicans say they'll vote against it. Facebook; Twitter. Google+. Email. Get The Stories That Grabbed Us This Week. Delivered to your inbox ...

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House Set To Vote On Republican Health Care Bill - NPR

New York Times

How the Rich Gain and the Poor Lose Under the Republican Health Care Plan New York Times An average family making more than $200,000 a year would gain $5,640 while a family making less than $10,000 a year would lose $1,420 if Congress passes the health care plan proposed by House Republicans, according to a new analysis. and more »

Go here to read the rest:
How the Rich Gain and the Poor Lose Under the Republican Health Care Plan - New York Times