WASHINGTON -- President Donald Trump and conservative lawmakers in the House agreed Friday to allow states to impose work requirements on able-bodied Medicaid recipients and to accept federal Medicaid funds as one annual lump-sum block grant.
The agreement on the revisions came as Republican leaders said the full House would vote next week on the bill to undo the Patient Protection and Affordable Care Act.
"I want everyone to know, I'm 100 percent behind this," Trump said at the White House, where he met with House members in the conservative Republican Study Committee. "These folks were no's, mostly no's yesterday, and now every single one is a yes."
Rep. Mark Walker, R-N.C., the Study Committee's chairman, said Trump personally asked each of the dozen committee members who gathered with him in the Oval Office to vote for the bill.
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"The president asked us specifically: Would we support him on this American Health Care Act" if the changes were made, Walker said. "We all agreed, to a man."
The concessions are significant, at least symbolically, and they are politically risky. President Barack Obama's administration refused to allow work requirements, saying they were not consistent with the goals of Medicaid, the health insurance program for low-income people. Several Republican governors have expressed interest in requiring healthy adults to have a job before receiving Medicaid.
On block grants, the initial House bill would end Medicaid as an open-ended entitlement to health care, replacing that with an allotment to the states for each Medicaid beneficiary. If, instead, states accepted lump-sum payouts, they would gain more freedom to administer the program and define eligibility and benefits -- but new enrollees would be taking money from a fixed pot. It is not clear which -- if any -- states would accept that option.
The changes could help win over conservative House members who have expressed concern or outright opposition to the bill for multiple reasons.
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"On balance and with the changes we agreed to in the bill's final text, I can vote for it," Walker said after the meeting in the Oval Office.
Rep. Bruce Westerman, R-Ark., who went to the White House as a member of the Study Committee, called it a "positive meeting."
"The president was very cordial and friendly and very businesslike, very prepared for our meeting," he said in an interview.
Westerman, as well as Arkansas Gov. Asa Hutchinson, had sought the revision that would allow Medicaid block grants.
"I've been working very hard to get block grant options in the health care bill, and we've got that in there now," Westerman said. "The president said he's 100 percent in support of that."
Rep. French Hill, R-Ark., also attended the meeting with Trump. In a statement Friday evening, Hill said he told the president that he backed the block grant proposal, predicting it would help the federal government save money and provide proper medical care to Medicaid recipients.
Changing the bill to win over conservatives risks alienating more moderate members of the House and Senate who worry that the measure could cause millions of people to lose health coverage. The Republican governors of four states -- Arkansas, Michigan, Nevada and Ohio, all of which expanded Medicaid under the Affordable Care Act -- drafted a letter this week formally rejecting the House bill as written.
The changes to the bill may not be enough for everyone, however.
A small but important group of hard-line conservatives remained engaged in a parallel negotiation with the White House and some senators in a bid to force more revisions to the bill.
"If I hear one more senator tell me that this bill is dead on arrival, I think my head is going to explode," said Rep. Charlie Dent, a moderate Republican from Pennsylvania. "That's certainly not something many members of the House find very appetizing -- voting for something that will go nowhere in the Senate."
Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus, said Friday that he can personally count about 12 senators and more than 40 congressmen who he expects would oppose the House GOP bill. He said those votes, combined with another large bloc of undecided members, guarantee the legislation cannot pass the House in its current format.
"There's not anywhere close to the votes," Meadows said in a Friday interview on C-SPAN's Newsmakers. "I can assure you that this bill needs to be changed."
Meadows said he is in talks with congressmen and senators, including Sens. Ted Cruz, R-Texas, Mike Lee, R-Utah, and Steve Daines, R-Mont., to craft several amendments to the leadership proposal. Those changes, he said, could be unveiled as soon as Monday.
The worries among lawmakers about people losing coverage intensified this week after the nonpartisan Congressional Budget Office estimated that, under the House bill, the number of people without health insurance would rise by 14 million next year and by 24 million by 2024.
Information for this article was contributed by Thomas Kaplan and Robert Pear of The New York Times; by Mike DeBonis, Abby Phillip and Kelsey Snell of The Washington Post; and by Frank E. Lockwood of the Arkansas Democrat-Gazette.
A Section on 03/18/2017