Paul Ryan foresees no major changes in Republican healthcare plan

U.S. House of Representatives Speaker Paul Ryan said on Wednesday the major elements of the Republican healthcare overhaul plan backed by President Donald Trump will remain intact despite conservative opposition to a bill whose prospects remain up in the air.

The White House and Ryan struggled to shore up support among Republican lawmakers for the legislation ahead of a key hurdle in the House Budget Committee on Thursday. Vice President Mike Pence was set to met with conservative House lawmakers and then the entire Republican House membership.

Ryan, who unveiled the legislation last week and is its main champion in Congress, said he was open to making "improvements and refinements," especially after an assessment on Monday by the Congressional Budget Office, which said millions of Americans would soon lose their health insurance under the plan.

Ryan indicated no appetite for wholesale changes, even as conservatives demanded major shifts relating to tax credits and the Medicaid health insurance program for the poor.

"Obviously, the major components are staying intact because this is something we wrote with President Trump. This is something we wrote with the Senate committees," Ryan told the Fox Business Network.

Senate Republicans voiced rising unease.

"As written, the House bill would not pass the Senate. But I believe we can fix it," Texas Senator Ted Cruz, a prominent conservative critic of the legislation, told reporters.

"It is mortally wounded," Republican Senator Lindsey Graham added on NBC's "Today" show, saying the bill was not good right now and that his party needed to "slow down" to get it right.

Ryan's comments follow Trump's promise on Monday of "a big, fat, beautiful negotiation" over the plan, the first major legislative initiative of his presidency.

Republicans control both Congress and the White House for the first time in a decade. But the bill, the Republicans' first major piece of legislation under Trump, remains in peril.

Democrats are unified against it, major medical providers have condemned it and conservatives oppose key elements.

The legislation guts key provisions of the 2010 Affordable Care Act, Democratic former President Barack Obama's signature legislative achievement popularly known as Obamacare. Obamacare enabled about 20 million previously uninsured Americans to obtain medical insurance.

Many conservatives call parts of the measure too similar to the law it is supposed to replace, want a quicker end to Obamacare's expansion of the Medicaid insurance program for the poor, and call the plan's age-based tax credits to help people buy private insurance on the open market an unwise new government entitlement.

Two House committees last week approved the bill's provisions with no changes, and the Budget Committee on Thursday will try to unify the plan into a single bill that would be sent to the House floor. Republicans cannot afford to lose more than three from their ranks on the committee for the measure to pass. Three committee Republicans are members of the hardline conservative House Freedom Caucus.

'LEGISLATIVE QUICKSAND'

Representative John Yarmuth, the committee's top Democrat, said the legislation "is in legislative quicksand."

"It is sinking of its own weight, and every time the Republicans try to move one way or another, it is sinking faster," Yarmuth said.

The U.S. Department of Health and Human Services released data showing that enrollment in the individual insurance plans created under Obamacare have declined to 12.2 million Americans.

The CBO, a nonpartisan congressional agency, forecast on Monday that the Republican plan would increase the number of Americans without health insurance by 24 million by 2026, while cutting $337 billion off federal budget deficits over the same period.

As of the end of January, enrollment in individual insurance plans created under Obamacare was down by about 500,000 people from 2016, it said. It is about 1.6 million people short of Obama's goal for 2017 sign-ups, the government said.

The data included people who selected or were automatically enrolled in an insurance plan between Nov. 1 last year and Jan. 31 either through the federal HealthCare.gov website or one of the state-based insurance exchanges. About one-third of the enrollees were new to the market.

Shares of hospitals traded broadly higher on Wednesday, with Community Health Systems rising 2.2 percent. Health insurer shares also gained, with Anthem up 2.8 percent after the insurer also backed its full-year profit forecast. After the release of the enrollment data, Leerink Partners analyst Ana Gupte said in a research note that: "While attrition is likely through the course of the year, the final enrollment points to a stable volume and bad debt outlook at least in 2017."

(Additional reporting by David Morgan, Lewis Krauskopf, Caroline Humer; Writing by Will Dunham; Editing by Chizu Nomiyama and Alistair Bell)