Some of the most conservative members of the House are at a crossroads over the plan from GOP leadership and the White House to replace the Affordable Care Act. Those lawmakers say their choice is between supporting a bill that goes against many of their principles, or falling in line behind President Trump — who won overwhelming support in their district.
"Do we need to lower the bar in what we believe as conservatives simply because a Republican is in the White House?" asked House Freedom Caucus member Mark Sanford, a Republican from South Carolina.
The overwhelming answer from members of the conservative caucus and other major outside conservative groups is no.
Most members of the Freedom Caucus have come around on Trump, even if many did not initially support him. Yet the divide over health care underscores the skepticism some conservatives still have with the White House and GOP leadership.
The new Republican health care bill, called the American Health Care Act, looks to be dead on arrival if party leadership can’t win over this group of about 30 lawmakers. House Committees are marking up the legislation on Wednesday.
There can only be 20 defections to get the bill to pass — if the Democrats remain united — and right now it looks like it will be far more than that, with many conservatives voicing their discontent. Sen. Rand Paul of Kentucky, for example, has called it "Obamacare lite" and considers it a bailout for insurance companies.
Conservative critics want a clean repeal of the Affordable Care Act, also known as Obamacare, and say that this new replacement plan does not comport with their principles. Among the issues they have with the bill is the tax credits the new plan provides, which could actually result in a rebate from the IRS to cover premiums, and the delay in doing away with the original law’s Medicaid expansion program.
The new battle lines between conservative groups and the White House-GOP leadership alliance have deep roots. Many of their members have long been skeptical of Trump and certainly weren’t behind him in the GOP primary — that includes Paul, a leading critic of the bill, who unsuccessfully ran himself. On Tuesday, Trump tweeted that his "friend" Rand Paul "will come along" with the plan. Paul has said the bill would not pass the House as is.
Trump expressed optimism on Tuesday that "everybody" would eventually support the House bill he’s now thrown his weight behind — even as members of the House Freedom Caucus and their allies on the Senate side held a press conference to malign the bill.
The president has repeatedly underscored that he believes he has a mandate to overhaul health care, given his win last November and GOP sweeps in Congress. In the areas these replacement bill holdouts come from, Trump did win, as he would say, "big league." He carried the districts of the House Freedom Caucus members by an average margin of about 26 points.
However, the lawmakers almost all won their races comfortably, and feel they too have a mandate from their constituents. They might even argue they have more purity on the issue, given Trump’s fluctuations on enumerating exactly what he wants in a health care bill and lack of specifics during the campaign.
Trump’s popularity has fallen since he took office, but he is still viewed favorably in the most conservative areas of the country. Trump himself seemed to acknowledge that could drastically change: Trump reportedly told House Republicans that the 2018 midterms could become a "bloodbath" if they fumble this health care bill.
At the same time, political action groups like the Club for Growth say they would use the vote in scoring how conservative a member is; a vote for the bill could mean a lower ranking, and more vulnerability for a primary challenge.
The Koch brothers-backed Americans for Prosperity says the members who stand up to oppose the new bill will have its full support going forward.
"From our perspective, bad policy equals bad politics as well," the advocacy group’s CEO, Luke Hilgemann, told NPR. "This proposal needs to go to the ash heap of history, as does Obamacare."