President Trump hosted a group of conservatives at the White House Friday — and he's reportedly given them what they want: big changes to Medicaid.
Lawmakers report the GOP health care legislation will now turn Medicaid into a block grant program run by states, and it will allow states to force recipients to get jobs before they get health care.
Those are considered major concessions to the conservative wing of the party.
Is this a preview of things to come? And will more moderate Republicans from the Philadelphia region find themselves on the outside?
U.S. Rep. Scott Perry, a Republican from Central Pennsylvania, is part of the tea party-aligned House Freedom Caucus. While his group has the ear of the president, he said it doesn't always seem that way.
"Look, we don't feel all that powerful, obviously. We're a lot of times, unfortunately, we're treated like pariahs around here," he said. "Everybody is very kind and all that stuff, but, let's face it, they're not thrilled with some of the positions that we take."
Have more moderate Republicans from the Northeast lost clout as the party moved further to the right?
U.S. Rep. Ryan Costello, who represents a district west of Philadelphia, said he doesn't think so.
"No, because I think we have our own way of evaluating things and making our points heard," he said. "And it's not necessarily through the press the way that they do it."
But the health care debate is testing the Republican Party, and it could reveal which direction the GOP goes in the near future when it comes to funding for Amtrak, after-school programs and even the environment.
'Different tribes from the same family'
The good news is that moderates and the tea party wing of the GOP share the same goal, said U.S. Rep. Tom MacArthur from South Jersey.
"These are different tribes of the same family," MacArthur said.
On the health care bill, while the White House has made promises to the far right, it still hasn't locked in the support of MacArthur and other moderates. He's lobbying to keep his state's Medicaid expansion in place for the next three years. But he also said the bill needs to do more to protect the poor and those in their 60s who aren't old enough for Medicare.
Surrounded by a flock of reporters with microphones and notebooks in tow, MacArthur disputed that conservatives are winning all the concessions.
"I'm not worried about that because I'm in the discussions," he said. "And I know all the back and forth."
Then there's Leonard Lance, another New Jersey Republican. His district begins in Hunterdon County and stretches across the state.
"I don't like the bill in its current form," Lance said.
The Congressional Budget Office dropped a bombshell on Republicans this week with an estimate that as many as 24 million people would eventually lose health insurance under the GOP plan.
In New Jersey, many people getting assistance from the government for insurance would also have to pay almost $1,300 more under the plan, according to the Center for Budget and Policy Priorities.
While conservatives say the CBO score doesn't matter, Lance said he needs reassurance that the plan covers more people.
"I would like to see a CBO score that is significantly different from the CBO score that was released earlier this week," he said. "I don't know whether that's possible."
In Pennsylvania, those getting tax credits instead of direct subsidies from the government would have to pay an average of nearly $2,200 more for insurance. In Delaware, they'd have to pay more than $2,300.
U.S. Rep. Charlie Dent from the Lehigh Valley is co-chair of a group of moderates Republicans known as the Tuesday Group. The more concessions made to the conservative wing of the party, Dent said, the harder it will be to hold on to the more moderate lawmakers for key votes.
"They have a very difficult needle to thread here. Any movement in one direction can cost votes from the other side," he said. "I think that's what they're grappling with, but a lot of us are looking at this issue right now in terms of the Senate.
"What in this bill is going to survive the Senate and what is not? And I think a lot of us would prefer to get a better sense of where the Senate is prior to the launch from the House. A lot of members here don't want to walk the plank for a bill that may not ever be passed by the Senate," Dent said.
For now, party leaders seem to be taking the concerns of the far right wing of the party more seriously than the concerns of moderates.
But as they put the health bill for a vote next week, moderate lawmakers from the region are hoping to play a larger role.
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