Conservatives want fast health law repeal, leaders cautious

WASHINGTON (AP) - Conservatives have demanded a quick vote on erasing much of President Barack Obama's health care law, with some threatening to oppose less sweeping legislation. But House Republican leaders said they were working deliberatively as the party continued its struggle to find a replacement that could pass Congress.

"This affects every person and every family in America," House Speaker Paul Ryan, R-Wis., told reporters on Tuesday. "That's why we're taking a step-by-step approach."

Ryan spoke the morning after the House Freedom Caucus unanimously agreed to insist on a fresh vote on a bill Obama vetoed last year, which would have killed much of his overhaul. Leaders of the caucus, whose roughly 40 members are among the House's most hard line conservatives, said they also want a simultaneous vote on a GOP package replacing that law.

Rep. Raul Labrador, R-Idaho, told reporters that if forthcoming GOP legislation annulling Obama's law doesn't go as far as last year's vetoed legislation, "We're not going to vote for that."

Rep. Mark Walker, R-N.C., leader of a broader group of conservatives, called the Freedom Caucus' demands "a common sense position" and said he wanted a vote "as soon as possible." He said at one closed-door meeting Tuesday where GOP leaders described options, lawmakers posed many questions and the reception was "intense"

In one unresolved dispute, conservatives oppose a Ryan idea to help people pay medical bills with refundable tax credits - which would mean checks from the IRS for people with little or no income. Conservatives say the idea invites fraud and removes an incentive for people to work, and Freedom Caucus leader Mark Meadows, R-N.C., said he believes the proposal lacks enough votes to pass.

Conservatives say they're worried that this year - with President Donald Trump eager to sign repeal legislation - lawmakers nervous about angering constituents who could lose coverage might water it down. GOP divisions include what to do about the law's expansion of Medicaid for poor people and its tax increases, and two senators have proposed letting states retain Obama's law entirely - anathema to conservatives.

"If we're just going to replace Obamacare with Obamacare light, it begs the question, 'Were we just against Obamacare because it was proposed by Democrats,'" Labrador said. Doing that would mean "our base is going to leave the party because they're not going to be happy," he said.

"At the minimum, we ought to be able to put on President Trump's desk exactly what we put on President Obama's desk," said Rep. Jim Jordan, R-Ohio, a conservative leader.

Despite their demands, conservatives share some of the same unresolved questions as other Republicans.

Conservatives said they're still not unified on how to address Obama's expansion of Medicaid to cover more low-income people. Some states opted to take billions in federal money to cover millions of people under the statute and would like to retain the expansion, but others oppose the program's enlargement.

Though Trump said days before taking office that his plan for replacing Obama's overhaul was practically ready, Republicans have yet to unveil legislation - just as they hadn't in the years since the law's 2010 enactment. Ryan has talked about repealing the statute and having a replacement plan ready in March.

"We want to get it right and we've been taking our time to do that," said Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee, among those writing the legislation. He said his panel would begin voting on a plan "in the near future."

Lawmakers say they expect their eventual package to include many elements that GOP leaders have long endorsed without providing details. These include phasing out Obama's expansion of Medicaid and repealing at least some of its $1.1 trillion in 10-year tax increases that financed the law's expanded coverage for 20 million people.

There would be federally subsidized high risk pools for sicker people who are costly to insure plus tax credits and health savings accounts to help people pay medical bills. And the proposal is expected to defang the law's unpopular fines for people who don't buy health insurance, and instead let insurers charge higher premiums for consumers who don't maintain continuous coverage.

Democrats have opposed all those steps, saying they would leave many people uncovered and make health care unaffordable for many others.