The American Health Care Act has now passed through three committees on its way to a vote on the House floor. So far, the Republican leadership’s replacement for Obamacare has emerged unscathed, and unchanged.
It is not likely to stay that way much longer.
Conservatives say they have the votes to defeat the measure, and they plan to introduce an amendment that would push it significantly to the right, likely by ending the Affordable Care Act’s Medicaid expansion earlier than 2020 and by allowing states to institute work requirements for recipients.
Their bid to change the bill will force Speaker Paul Ryan to make a critical decision: Accept a significant amendment that could mollify the right at the expense of party moderates, or risk an embarrassing defeat on the floor of the House that would smash the GOP’s top legislative priority.
Increasingly, it seems the choice is being forced on the speaker. As of last week, Ryan had told reporters that Republicans in the House and Senate faced a “binary choice” on the health-care bill, resisting all but the most minor tweaks to the legislation. That position came under fire immediately, first from conservatives who quickly called his bluff, then from Republicans who warned House leaders that their bill wouldn’t come close to the 51 votes it needs to pass the Senate. Ryan got little help from President Trump, who repeatedly told conservative lawmakers and activists during White House meetings that the bill was open to negotiation.