As President Donald Trump prepares to address Congress for the first time Tuesday night, Republican lawmakers called on him to address growing tension in the party over how to repeal and replace the Affordable Care Act.
Although Republican lawmakers agree that President Barack Obama's signature healthcare reform law must be changed, Congress and the White House have yet to agree on the details of that plan.
Two leading House conservative groups have both announced that they object to leaked GOP draft plans to use new tax credits to help consumers buy insurance. They say there is no way the proposal will pass in the U.S. House of Representatives.
Three key conservative senators, Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas, have said they will resist "Obamacare Lite" and "accept nothing less than full repeal of Obamacare."
That outcry has been amplified by Republican governors who expanded Medicaid in their states after the ACA was enacted. GOP governors are urging Congress to change Medicaid from an open-ended federal entitlement program to one with a funding limit that's designed by individual states.
Avalere Health consultants were commissioned by the National Governors Association to analyze how state budgets and residents in expansion and non-expansion states would be affected by congressional Republicans' proposals to change Medicaid into a per capita program or one that distributes block grants. Republicans in Congress are floating the ideas as alternatives to rolling back Medicaid expansion made possible through the ACA.
If those proposals were implemented, up to 51% of those who purchased coverage through the ACA marketplace could lose coverage in non-expansion states, while those that did expand Medicaid eligibility could see coverage slashed by 30%.
But Republican leadership is urging its members to “stay strong,” according to Rep. Dennis Ross of Florida, who called on Trump to settle the issue in Tuesday evening's speech.
"He's the leader on this issue right now; he's the one that's got to hold us together," Ross said about Trump.
House Speaker Paul Ryan of Wisconsin downplayed the divisions, saying “churning” is expected with any legislative product of this nature. “This is a plan that we are all working on together, the House, the Senate and the White House, so there aren't rival plans,” he said.