WASHINGTON - Two Republicans from the Philadelphia area are now on record backing the GOP plan to repeal and replace the Affordable Care Act.
But as the legislative push continues this week, most Republicans from the region remain publicly undecided on their party's top priority, and as the plan shifts, so could their views.
To a man, they say they want to repeal or reform the law often called Obamacare, but many have raised questions about the specifics of this proposal. Here is where they stand so far. (Every Democrat from the area has spoken out in opposition).
In Support
Rep. Ryan Costello — As a member of one of two committees that vetted the repeal plan last week, Costello, of Chester County, voted in favor of the measure.
"It's the appropriate framework through which to bring about the kind of reforms that we need to stabilize the insurance market, to protect those that have pre-existing conditions from price discrimination, to treat those within the Medicaid expansion population fairly, but also to look to rein in health care costs and get us on a path forward where we don't have government-centered, government-controlled health care," he said in an interview.
Costello stressed that the bill will change as it moves through Congress. He also emphasized that changes to Medicaid would not arrive until 2020 — but that timetable could be sped up to next year if more conservative House members get their way, a change which might threaten support from local Republicans from more moderate districts. (More on that below).
Rep. Pat Meehan — The Delaware County representative also got an early vote, as a member of the House Ways and Means Committee. He backed the bill, while raising concerns about the Medicaid provisions and pledging to review their impact on Pennsylvania.
The legislation "isn't perfect, but it eliminates one-size-fits-all Washington mandates and instead gives consumers the ability to purchase the insurance that meets their needs. It will help bring the individual insurance markets out of the death spiral they're in today. And it will drive down costs by increasing competition and flexibility," a Meehan spokesman wrote in an email. "The alternative is the status quo of skyrocketing premiums and less choice in plans and providers for Pennsylvania families."
On the fence
Rep. Charlie Dent — One of the House's most vocal centrists, Dent was among just nine Republicans to vote against an earlier step that set the repeal in motion. He issued a careful statement when this plan was rolled out.
"I am pleased that the bill fully repeals the jobs-destroying medical device tax, addresses over-reaching government mandates, and includes some elements of replacement. I remain concerned, however, about the impact of the Medicaid changes on vulnerable populations, as well as the overall effect of the bill on access to affordable care."
Rep. Brian Fitzpatrick — Fitzpatrick was also among the nine who opposed the initial procedural vote on repealing the law, worried that his party didn't have a replacement prepared. The freshman from Bucks County said he would carefully review this plan.
"The Congressman's focus when it comes health care reform has been continuity of coverage, extension of patient protection provisions and encouraging competition – including across state lines – to drive down the cost and increase access," a spokesman wrote in an email. The bill, he added, "will likely undergo several adjustments."
Rep. Frank LoBiondo — The South Jersey Congressman voted in favor of the earlier repeal steps, but has said little about the specifics of this bill. He wrote on Facebook Saturday that he is continuing to review the plan and "having meetings with my colleagues to see if we have any opportunities to improve the bill, and await additional analysis." A key estimate of the law's impact is expected this week from the nonpartisan Congressional Budget Office.
Rep. Tom MacArthur — MacArthur, also of South Jersey, has repeatedly said he would not support a bill that abandons the needy and that he worries about the consequences for New Jersey if the Medicaid expansion is rolled back, even though he believes Obamacare needs reform.
"I'm telling you honestly I don't know how I'm going to vote," he said at a recent town hall. "If we pull the rug out from under the most vulnerable, I can't support that."
He also voted against that initial procedural step — making it three of nine GOP "no" votes from this area, a sign of just how thorny this issue is in moderate districts.
Sen. Pat Toomey — The bill isn't through to the Senate yet, but some senators are still making their voices heard, with both moderates and conservatives calling for modifications — in opposite directions. Toomey, as he often does on controversial votes, is keeping his views to himself for now. He told the Inquirer he was still reviewing the plan and late last week told WPHT radio host Chris Stigall, "This is not the final product."
In fact, House conservatives, backed by some of the right's most influential lobbying groups, are threatening to derail the GOP replacement plan, arguing that it doesn't go far enough to wipe out former President Barack Obama's signature health law.
Late last week President Trump suggested he would be open to negotiating. But if he and House Speaker Paul Ryan move rightward, it may risk support from this area's delegation, which represents more moderate districts. While conservatives want to act faster to roll back the law's Medicaid expansion, local Republicans have specifically cited Medicaid as an issue they'd like to move carefully on.
It adds up to a complicated game for GOP leaders who have to decide how many votes each tweak gains and loses.
You can follow Tamari on Twitter or email him at jtamari@phillynews.com.
