Donald Trump Faces a Conservative Revolt in Congress

When Mr. Trump delivers his first address to a joint session of Congress Tuesday night, he will confront restive bands of conservative and centrist lawmakers openly rebelling against the GOP leadership’s plans for replacing the Affordable Care Act and rejecting elements of the president’s first budget proposal.

Republican leaders have long counted on Mr. Trump’s influence — through his bully pulpit and Twitter feed — to help keep their ranks in line. Now, with Republicans splintering on key elements of the nascent plan to repeal and replace the Affordable Care Act, Mr. Trump’s ability to claim any major legislative accomplishments will depend on whether he can coerce them into cooperation.

In particular, conservatives are rejecting their leadership’s proposal to provide tax credits to help cover the cost of health insurance for people who don’t get insurance through their employer.

“We can’t have multiple quarterbacks,” Rep. Steve Stivers of Ohio, chairman of the House Republicans’ campaign arm, said Tuesday. Mr. Trump “will be helpful in getting some of our more conservative folks to understand that this is a unifying plan” to unwind the 2010 health law, he said.

In the House, Republicans can afford to lose no more than 22 GOP votes if they want to advance legislation without Democratic support. But the leaders of two conservative groups have said they can’t support the health insurance proposal.

Rep. Mark Walker (R., N.C.), chairman of the Republican Study Committee, and Rep. Mark Meadows (R., N.C.), chairman of the House Freedom Caucus, have both objected to the proposal’s tax credits, whose value would be pegged to a recipient’s age, not income.

To pay for the tax credits, House Republicans are considering capping how much of an employee’s health benefits can be shielded from income and payroll taxes — a broad move that would affect as many as 178 million Americans.

“It says millionaires can get just as much of a tax credit and check from the federal government,” Mr. Meadows said of the GOP leaders’ proposal. “And we’re going to pay for that by putting a tax on union workers and middle-class workers that happen to have good employer insurance — that dog doesn’t hunt.”

In the Senate, where Republicans can lose no more than two votes to pass legislation without Democratic support, three conservative GOP senators said Monday night in a coordinated series of tweets that they would oppose any legislative effort that fell short of a full repeal of the 2010 health law.

The current House GOP proposal would topple parts of the law — some immediately, others after a transition period — and seek to include some elements of a new, GOP-created health system. It would also allow some states to preserve their Medicaid population, if it had been expanded under the Affordable Care Act, for an undetermined period.

“Congress must keep its word. We were elected to fully repeal and replace Obamacare, and that’s the only thing I will vote for,” Sen. Rand Paul (R., Ky.) said in a statement.

He was joined on Twitter by Republican Sens. Mike Lee of Utah and Ted Cruz of Texas, who urged GOP leaders to bring to the floor legislation that Congress considered in 2015 and passed in early 2016 that would gut major chunks of the law, without including any elements of a plan to replace it. That legislation was vetoed by former President Barack Obama.

Conservative groups, including the Club for Growth and FreedomWorks, are rallying behind the 2015 bill, because they know that it can meet the strict procedural requirements in the Senate that allow Republicans to pass health legislation with just a simple majority. Most bills need 60 votes to clear procedural hurdles in the Senate, where Republicans hold 52 seats.

Many Republicans are also uncomfortable with components of Mr. Trump’s first budget proposal, which administration officials outlined Monday. The president will call in Tuesday night’s speech for a $20 billion boost in current military spending and sharp cuts in other programs, without seeking the curbs on Medicare and Social Security that fiscal conservatives say are necessary.

Some defense hawks, including the chairmen of the House and Senate Armed Services committees, said Mr. Trump’s military budget falls short of what is needed to keep the armed forces ready and the country safe.

Sen. Lindsey Graham (R., S.C.) said Tuesday that Mr. Trump’s proposed State Department budget was “dead on arrival” because its cuts would put “diplomats at risk.”

Meanwhile, many conservatives dismissed Mr. Trump’s reluctance to lower spending on the two big safety-net programs, Social Security and Medicare, saying they were optimistic he would change his mind as he spends more time grappling with the urgency of the federal budget deficit.

“If he’s here for eight years, he could potentially see Medicare go bankrupt while he’s president,” Mr. Meadows said. “We’re hopefully going to give him a very persuasive argument on how he can save it.”

Mr. Trump and GOP leaders in Congress also have a challenge in satisfying centrist Republicans, who also have the power to derail the health bill. Those Republicans have said they won’t vote to repeal the health law without providing nervous constituents a plan for its replacement.

Many are also concerned about how states that expanded their Medicaid programs under the health law will fare when it is repealed.

“We are a state that expanded Medicaid, so I have to have some assurances that some 20,000 that now have coverage, that we’re not just dumping them,” Sen. Lisa Murkowski (R., Alaska) said recently.

Mr. Trump met with governors and health insurance CEOs Monday and vowed to replace the health law.

“Nobody knew that health care could be so complicated,” the president said, alluding to the challenge he will face in attempting to rally a fractured GOP.

“There is a world of divide there,” Rep. Mark Sanford (R., S.C.) said.

 Dow Jones Newswires

 MORNING STAR