The House Budget Committee approved the GOP's ObamaCare repeal and replacement plan 19-17 Thursday morning, with three Republicans voting no.
Republican Reps. Dave Brat (Va.), Mark Sanford (S.C.) and Gary Palmer (Ala.) voted against advancing the bill.
All three men are members of the conservative House Freedom Caucus, which opposes the bill some have called "ObamaCare lite" because it leaves in place several of ObamaCare's provisions and insurance mandates.
Speaker Paul RyanPaul Ryan3 reasons Devin Nunes must step away from the Trump probe Wounded Ryan faces new battle Can Trump rebound after failure on healthcare bill? MORE (R-Wis.) told reporters the Budget panel’s action puts Republicans “another step closer toward keeping our promise to repeal and replace ObamaCare.”
“Repeal and replace will be a step-by-step approach,” he said. “We are very pleased with where we are because we are on track and on schedule with where we’ve intended to be this whole time.
“We made a promise to repeal and replace Obamacare. We’re going to keep our promise to the people who elected us.”
The bill will now head to the House Rules Committee, where leadership might make amendments to appease conservatives and moderates unhappy with the current legislation.
The Rules Committee will be the final stop before the bill reaches the floor.
House Freedom Caucus Chairman Rep. Mark Meadows (R-N.C.) also said Wednesday he would offer an amendment to leadership Friday, but has not said what it would be.
In her opening remarks, Budget Chairwoman Diane BlackDiane BlackObamaCare repeal faces last obstacle before House vote Medicaid block grants give states more freedom Dems wonder: Can GOP even pass a budget? MORE (R-Tenn.) urged conservatives to stay in the discussions and work toward building a better product.
"To my Republican colleagues who have doubts today, I encourage you: Don't cut off discussion. Stay in this effort and help us enhance this proposal by advancing it out of committee and pushing for further conservative reforms," she said.
"Members who desire to see this bill improved have every right to make their voices heard."
Along those lines, the committee approved four non-binding recommendations from Republicans that will be sent to the Rules Committee, including a work requirement for able-bodied adults enrolled in Medicaid and another that would gear the plan’s refundable tax credits toward low-income people.
Under the current GOP plan, the credits are based on age, not income, for people making up to $75,000. After that, for every $1,000 someone’s income goes up, they would lose $100 in tax credit.
But some Republicans have said those tax credits are too generous for those who have higher incomes and wouldn’t do enough for older, low-income people. Two Democrats also supported the recommendation.
“I think this amendment is making sure we don’t give a birthday present to the rich,” Sanford said, adding that it would “target aid to those who most need it.”
If the tax-credits are adjusted to provide more help to lower-income people, it could help bring moderates onboard.
The work requirement, too, is generally supported by both conservatives and moderates.
“A work requirement would help states focus their resources on the truly needy,” Palmer said.
Another motion approved by the committee would recommend giving states the option to accept their Medicaid funding through block grants. The current GOP plan only allows per-capita caps.
Members of the Freedom Caucus are clamoring for changes to the legislation. They warning the bill creates a new entitlement program by providing refundable tax credits to help people buy insurance. Other members want the changes to Medicaid in the legislation to take effect earlier.
The White House this week said it was working with leadership on a manager's amendment to the bill, but did not provide details.
The Republican Study Committee wants the bill to include a quicker Medicaid freeze and work requirements for Medicaid recipients. Rep. Mark Walker (R-N.C.), the chairman of the RSC, said after a meeting with Vice President Pence this week that he's hopeful those changes would be included in the manager’s amendment.
The chairman of the House Freedom Caucus also said Wednesday he would offer an amendment to leadership Friday that he says could absolve both conservative and moderate concerns.
House Republican leaders have little margin for error once the healthcare bill reaches the floor.
At least 15 Republicans have said they will vote against the bill or are leaning against it, according to The Hill's Whip List, while many more are undecided. Twenty two defections would be enough to defeat the bill on the floor.
In the Senate, meanwhile, some Republicans are privately rooting for the House bill to go down, given the challenges that they could face in trying to pass the measure.
“Right now this is disintegrating in the Senate, with everyone off on their own about what they don’t like about the bill,” said a Republican senator who requested anonymity to speak freely about the bill.
— This report was updated at 4:08 p.m.