President Donald Trump on Tuesday nodded to the long road ahead.
"Our wonderful new Healthcare Bill is now out for review and negotiation," he tweeted, while also calling Obamacare "a complete and total disaster."
The House Freedom Caucus and Senate allies say it's Obamacare lite
The most vocal opposition to date has come from the tea party and its descendants in the House. Many of them campaigned on promises of "full repeal." But the bill on the table right now is closer to a restructuring, then eliminating Obamacare.
Though it would scrap the current mandate, the new proposal includes an inducement to stay insured, in the form of a 30% surcharge on a year's premium, for anyone who allows their coverage to lapse or drops it, then seeks to re-enter the market. Conservatives also view the prospect of a refundable tax credit to help pay for insurance as another "entitlement," or government spending program.
In an interview on Monday, Ohio Rep. Jim Jordan, a former Freedom Caucus chairman told CNN's Lauren Fox
that the new plan is "in many ways is Obamacare by just a different format." Jordan and his colleagues are pushing a separate proposal that doesn't figure to get much attention from party leaders.
Michigan Rep. Justin Amash said about the same on Monday night, tweeting that the replacement bill amounted to "Obamacare 2.0."
Freedom Caucus Chairman Mark Meadows began to share his concerns last week, before the plan went public, tweeting, "Every tax, every mandate, every regulation of #Obamacare needs to go."
On Monday, he published an op-ed
with Sen. Rand Paul calling on GOP leadership to "move forward with a 'clean' repeal," effectively detaching the debate over a replacement bill from a vote to strike down Obamacare.
Paul on Tuesday unleashed a string of complaints, doubling down on his assertion that the plan is not fundamentally different from the current law, but "Obamacare Lite."
"It keeps Obamacare subsidies," he tweeted, "but renames them 'refundable credits.'"
A larger group of House fiscal conservatives, the Republican Study Committee, has similar misgivings. In a staff memo obtained from a GOP source, the RSC cites among its "major concerns" the creation of a "Republican welfare entitlement" in the form of the proposed refundable tax credits.
"Writing checks to individuals to purchase insurance is, in principle, Obamacare," the memo says
The moderate Republican Senate holdouts are worried about Medicaid
The pressure is not coming exclusively from Democrats and the Republican right. A group of four more moderate Republican senators wrote a letter to Majority Mitch McConnell on Monday expressing their concern over potential cuts to Medicaid, which would be targeted for a broad overhaul.
Obamacare's expanded federal funding would be phased out and the states would eventually receive a fixed amount of money for each enrollee in the broader program, allotted per recipient. Cost overruns would be footed by the states, which would, experts say, likely be forced to reduce eligibility and benefits.
In their message to McConnell, GOP Sens. Rob Portman, Shelley Moore Capito, Cory Gardner and Lisa Murkowski, expressed worry that the plan would not adequately protect
those covered by Medicaid expansion.
"We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services," they wrote. "The Medicaid population includes a wide range of beneficiaries, many of which cycle on and off Medicaid due to frequent changes in income, family situations, and living environments."
The letter was noteworthy for another, more pragmatic reason: four Republican votes against the bill, along with a united Democratic opposition, would be more than enough to sink it.
Outside groups and big dollar donors are getting ready to fight on TV
Many of the groups, think tanks and donors that helped bolster the GOP congressional majority are now openly at odds with the leadership.
FreedomWorks, a conservative group that provided early support to the tea party, has called the bill's "surcharge" on people who let their coverage lapse a "Republican Individual Mandate."
They announced on Tuesday evening plans to spend "well into six figures" on a "digital and social media ad campaign to mobilize conservatives in key districts and nationwide to contact their legislators and tell them to oppose ObamaCare Lite."
The Koch Brothers-backed Americans for Prosperity tweeted a message for Speaker Paul Ryan: "Our advice: Take it back to the drawing board."
In a letter
to Ryan, and the architects of the plan, Reps. Kevin Brady and Greg Walden, AFP and Freedom Partners said on Tuesday that "as the bill stands today, it is Obamacare 2.0"
"We urge you to keep your promise," they write, "reject the House bill, and pass the full Obamacare repeal that Americans deserve."
Also on Tuesday, The Heritage Foundation tweeted
that "the House Republican health care bill falls short of the Obamacare repeal that Republicans have long promised."
And in a statement
, Heritage Action CEO Michael Needham argued that the plan is so similar to Obamcare that it effectively enshrines its principles.
"In many ways, the House Republican proposal released last night not only accepts the flawed progressive premises of Obamacare but expands upon them," Needham said, then joining the chorus asking to divide the replacement process from the repeal.
"Rather than accept the flawed premises of Obamacare," he continued, "congressional Republicans should fully repeal the failed law and begin a genuine effort to deliver on longstanding campaign promises that create a free market health care system that empowers patients and doctors."
The Trump administration is ready to negotiate
Health and Human Services Sec. Tom Price, a former Georgia congressman who has long sought to upend Obamacare, kicked off the White House press briefing on Tuesday by calling the bill "a work in progress," indicating that the administration was open to edits from Capitol Hill.
Press Secretary Sean Spicer passed on a chance
to call the plan Trump's, saying, "We're not jamming it down anyone's throats."
And Vice President Mike Pence, who met on Tuesday with Republican senators, told reporters that Trump "supports" the bill, describing it as a "framework for reform."
The White House will be the final hurdle for Republicans, who have spent years agitating to undo Obamacare.
"We're going to have insurance for everybody," Trump told the Washington Post
in January, promising the new product would arrive "in a much simplified form. Much less expensive and much better."
How those pledges mesh -- or don't -- with the congressional GOP's final product could decide the fate of Obamacare and the officials dedicated to seeing it torn down.