Medicaid work requirements could be added to ObamaCare bill

House Republican lawmakers from different factions of the caucus say they are open to adding Medicaid work requirements to their ObamaCare replacement bill, a measure that could help bring conservatives on board without alienating moderates. 

Medicaid work requirements were one of the main additions that the conservative Republican Study Committee asked for in a meeting with Vice President Pence on Wednesday as leadership looked at changes to the bill to help win more votes.

House Freedom Caucus Chairman Mark Meadows (R-N.C.) also called for Medicaid work requirements.

“We’ve been consistent in saying a 20-hour work requirement in Medicaid would be a prudent thing to do,” Meadows told reporters Wednesday night. 

Freedom Caucus members say work requirements alone are not enough to get them to support the bill. Conservatives are also pushing for a range of other changes, including moving up the freeze of ObamaCare’s expansion of Medicaid to 2018 and repealing insurance regulations such as the essential health benefits. 

{mosads}Meadows told reporters Wednesday night that leadership does not have the votes to pass the bill as it is. He estimated there are 40 to 50 no votes among House Republicans at the moment, more than enough to prevent the bill from passing, along with 20 undecided votes.  

Most of the discussion outside of the conservative wing has centered on relatively small changes to the bill. Alterations being considered include codifying some regulatory changes that the Trump administration could make, and allowing insurance to be sold across state lines, said Rep. Luke Messer (R-Ind.), chairman of the Republican Policy Committee.

However, unlike the Medicaid freeze change, the work requirements appear less likely to alienate moderate Republicans and therefore are a more likely addition to the bill. 

Rep. Charlie Dent (R-Pa.), co-chairman of the centrist Tuesday Group, said “a lot of us could” support work requirements. 

“I think most Republicans, with the right language, could support that,” added Rep. Fred Upton (R Mich.), another Tuesday Group member and a former House Energy and Commerce Committee chairman. 

Messer said he would support adding work requirements to the bill. 

There is some difference of opinion, though, as to whether the change should only allow states to require Medicaid recipients to work, or whether it should go further by requiring states to make the change. Meadows said he wants the work requirements change to be mandatory. Rep. Morgan Griffith (R-Va.) has a measure to just allow states to make the change.

There is also a question as to whether work requirements could pass muster under Senate rules for the fast-track reconciliation process.

Lawmakers are also looking at dropping a 30 percent premium surcharge on people who had a gap in coverage. The Congressional Budget Office found that provision could actually discourage healthy people from enrolling, the opposite of the intended effect.  

Conservatives have pushed for moving up the date of the Medicaid expansion freeze from 2020 to 2018, but that idea is getting resistance from moderates. 

Upton said that he raised concerns about the idea in a Tuesday Group meeting with Pence on Wednesday. 

“It does concern me,” Upton said. “I spoke to my governor earlier this afternoon, and I’m hopeful that that date doesn’t change, knowing that there’s a transition period that helps states like mine that did expand.”

The Freedom Caucus’s main concern is to repeal ObamaCare regulations on what health services an insurance plan must cover, known as essential health benefits. Conservatives say those regulations drive up costs. 

Rep. Raúl Labrador (R-Idaho), a Freedom Caucus co-founder, told The Hill he is open to work requirements but that it wasn’t enough to get him and many other conservatives on board with the bill.

House Republican leaders were doing a whip count of where lawmakers are on the bill during votes Wednesday night. 

Speaker Paul Ryan (R-Wis.) did not discuss potential changes to the bill as he huddled in a closed-door meeting Wednesday night with Pence and rank-and-file House Republicans.

Ryan also would not weigh in on potential changes during a news conference after the meeting, though he specifically was asked about the work requirements provision and the idea of incorporating Health and Human Services Secretary Tom Price’s administrative changes into the underlying health bill.

“What’s happening in this legislative process is we’re getting feedback from various members on how we can improve the bill. Now that we have the [CBO] score, we know exactly what we’re dealing with,” Ryan told reporters.

“It’s premature to get into the conclusion of those things.”

House Republicans will also vote next week on two other health-related bills that are part of the third phase of the ObamaCare repeal-and-replace process, Majority Leader Kevin McCarthy (R-Calif.) said Wednesday.

They are the Competitive Health Insurance Reform Act, which McCarthy said eliminates anti-trust protections for insurance providers, and the Small Business Health Fairness Act, which allows small businesses to pool together to purchase plans for their workers.

— Jessie Hellmann contributed.