With conservatives in revolt on health care, moderates might be Trump's new best friends

WASHINGTON — Conservative House Republicans have attracted most of the attention as GOP leaders scramble to shore up support for their health care bill, but the party's moderates are emerging as key players in deciding whether the Republican replacement for Obamacare is approved by the House this week.

The vote on the health care bill is expected to be close, so opposition from either the right or the left side of the GOP caucus could kill it when it comes to the House floor on Thursday. Democrats oppose the legislation, which they say will raise costs for many Americans while providing less medical coverage. Members of the conservative House Freedom Caucus have been broadly critical of the bill for not going far enough in getting rid of Obamacare's regulations. So Speaker Paul Ryan, R-Wis., needs every GOP moderate to stand with him to get the bill through the House; if more than 21 Republicans vote 'no,' the bill will not pass the House.

Recognizing the moderates' clout on the issue, the conservative Club for Growth announced Tuesday that it is launching a $500,000 ad campaign urging 10 centrist Republicans to vote against the GOP bill despite the fact that Republican leaders say it is their party's best chance to repeal and replace Obamacare.

"The RyanCare bill fails to keep President Trump’s promises of interstate competition and health insurance deregulation,” said Club for Growth President David McIntosh, who has named the bill after the House speaker, who led the drafting of the bill. “Republicans promised a bill that would stop Obamacare’s taxes and mandates, and replace them with free-market reforms that will increase health insurance competition and drive down costs. RyanCare fails on those counts and that’s why the Club is letting millions of constituents know that their representative should reject RyanCare.”

The ad campaign, which will air on TV and digital platforms, will run in the congressional districts of Reps. Leonard Lance and Tom MacArthur of New Jersey, John Katko and Peter King of New York, Brian Fitzpatrick and Charlie Dent of Pennsylvania, Rob Wittman of Virginia, Ileana Ros-Lehtinen of Florida, Darrell Issa of California and Don Bacon of Nebraska.

Read more:

Controversial measure added to Republican health care bill to lure New York votes

Trump to House Republicans: Time to put up or shut up on Obamacare repeal

Sen. Ron Johnson is skeptical that House GOP health care bill can pass in 2017

Many of those members have already expressed skepticism about the bill.

"I campaigned in support of a repeal and replace bill that would make health care more affordable and accessible and provide a smooth transition to those who were forced into Obamacare through no fault of their own," Lance said Tuesday after GOP leaders made changes in the bill, largely to try to appease conservatives. "The bill, as currently drafted, does none of these things. What’s more, important ideas like purchase of policies across state lines, small business pooling and medical malpractice reform are absent from the legislation."

Ros-Lehtinen has also announced her opposition to the bill.

"After studying the impact of this proposed legislation on my district and speaking with many of my constituents, I have decided to vote 'no' on the bill as currently written," she said in a statement. "Too many of my constituents will lose insurance and there will be less funds to help the poor and elderly with their healthcare ... We should work together to write a bipartisan bill that works for our community and our nation without hurting the elderly and disadvantaged among us."

Fitzpatrick, in a recent Facebook post, said he is worried that the bill's proposed changes to Medicaid coverage would make it more difficult for the growing number of Americans addicted to opioids to get treatment.

"I have many concerns with this bill, and first among them is the impact on the single most important issue plaguing Bucks and Montgomery Counties, and the issue that I have made my priority in Congress: opioid abuse prevention, treatment and recovery," he wrote.

However, MacArthur told reporters that he supports the bill and believes a majority of the moderate Tuesday Group will, too. The Tuesday Group is made up of about 50 GOP House members, and MacArthur is one of its leaders.

"Does every group get everything they want? No," he said on Tuesday. "But if you're negotiating in good faith and you get a large amount of what you want, it's time to come around the bill and try to get others around the bill."

Reflecting the importance of this group, Trump had a small group of them over to the White House on Tuesday afternoon, including co chairs Dent, MacArthur and Rep. Elise Stefanik, R-N.Y.

Trump also made a trek to the Capitol on Tuesday morning to appeal to the entire Republican caucus, particularly its most conservative wing, to support the bill. He emerged from the meeting expressing confidence. "We're going to have a real winner. It was a great meeting. They're terrific people," Trump said. "They want a tremendous health care plan, which we have. There are going to be adjustments made. I think we'll see the votes on Thursday."

But Trump also warned the lawmakers that if the bill dies, the party could lose the majority in Congress in 2018.

But GOP leaders are facing a rebellion by the conservative House Freedom Caucus. The group, which is made up of about 40 members, has not taken an official position on the bill, but many of its members have criticized the legislation for failing to go far enough in dismantling Obamacare's regulations.

Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, said Tuesday that he is not yet satisfied with the bill, despite changes made late Monday by GOP leaders.

"I remain skeptical that this bill actually will protect our working poor, those that are older and are most vulnerable from a health coverage standpoint," he said. "And we will continue to work in a direct manner with our leadership and the White House to hopefully get to a point where we can make sure that all Americans are better served by our health care policy."

Contributing: Herb Jackson and Eliza Collins