WASHINGTON _ The Republican bill to replace the Affordable Care Act will face its biggest test so far Wednesday, as a House committee filled with conservatives could derail the legislation backed by Speaker Paul Ryan before it gets to the House floor.
If four Republicans join Democrats in voting against the bill in the House Budget Committee, the legislation will fail.
The uncertainty comes after the nonpartisan Congressional Budget Office released its report on the bill. It predicted that 24 million people would lose health coverage by 2026, but that there would be a cut to the federal budget deficit of $337 billion over the first decade.
At least seven Republican members of the Budget Committee have made public statements in the past week indicating they want a full repeal of President Barack Obama's health care law, but it's unclear whether four of them will decide to go out on a limb and vote no.
One of them, Mark Sanford of South Carolina, joined Sen. Rand Paul, R-Ky., at a news conference last week at which they called the legislation a dereliction of the Republican Party's campaign promises.
"Inasmuch as President Trump views many things as a negotiation, I'm quite sure he would rarely take any party's opening bid," Sanford said. "The debate that is forming will allow conservatives to enhance and improve what has been proposed, and I think this could represent a win for patients, health care providers and the taxpayer alike."
Expressing concern is one thing, but a "no" vote by any GOP member in committee is another _ a calculated risk for rank-and-file Republicans.
A "no" vote would anger Republican leadership and potentially make it harder to overturn even portions of the Affordable Care Act, while a "yes" vote would not ensure that the final bill on the House floor will appeal to conservatives who want a full repeal.
Unlike last week, when the bill made it through both the Energy and Commerce and the Ways and Means committees with little Republican opposition, members of the ultra-conservative Freedom Caucus and other conservative lawmakers who sit on the Budget Committee will have their chance to make a political statement.
Three members of the Budget Committee _ Sanford, Dave Brat of Virginia and Gary Palmer of Alabama _ are members of the Freedom Caucus, a group of lawmakers who have voiced concerns about the legislation. Brat has gone one step further, indicating that he will vote against the bill as written.
If those three choose to vote "no," only one other Republican "no" is needed to kill the bill, and there are many options.
Freshman Rep. Matt Gaetz, R-Fla., was a vocal opponent of the current law during his campaign, and said, "I come to bury Obamacare," in one of his first speeches in Congress.
Rep. Tom McClintock, R-Calif., a former Freedom Caucus member, said he was "looking at it" when asked last week whether he supports the bill.
Rep. Glenn Grothman, R-Wis., is concerned with how many employers would provide coverage under the Republican-sponsored plan.
"As drafted, the current replacement plan could result in even less people on employer plans than under Obamacare _ with the credits possibly creating an incentive for employers to drop coverage," Grothman said in a statement.
The Budget Committee is a largely procedural body, and it will not consider amendments to the bill.
Chairman Diane Black, R-Tenn., will hear about a half-dozen procedural motions during the hearing Wednesday before moving to vote on the legislation, where conservative rank-and-file Republicans will have their shot to steal the national spotlight.
