Bloomberg) — House Speaker Paul Ryan doesn’t plan to make major changes to Republicans’ plan to de-funding the Affordable Care Act, according to a GOP aide, but the White House says it’s talking with members of Congress who want to amend the legislation.

“We’ve always stated a willingness,” Sean Spicer, White House spokesman, told reporters Tuesday in Washington. “Part of the reason we’re engaging with these individuals is to hear their ideas.”

Related: AARP says GOP plan burdens older, lower-income Americans

Rep. Mark Meadows of North Carolina, chairman of the House Freedom Caucus and an opponent of Ryan’s plan, said, “I think we’re making real good progress with the White House and leadership, and I’m optimistic that we’ll see some good results in less than a week.”

Ryan and House Majority Leader Kevin McCarthy are speaking with President Donald Trump by telephone Tuesday afternoon to discuss the next steps.

House Republicans are in a bind following a Congressional Budget Office estimate showing that 14 million Americans could lose their insurance next year under the GOP ACA de-funding plan. The CBO gave a dire picture of the bill’s effects heading into the 2018 congressional elections.

Related: CBO sees AHCA cutting $337 billion from the deficit

At the same time, insurance premiums will continue to rise in the near term, especially for older Americans. Starting in 2020, older, poorer Americans will have far less help from Republican tax credits than they get through Obamacare subsidies.

Rethinking the plan

Even as the Trump administration challenged the CBO estimate, concern is growing that the analysis suggests the party may need to rethink its plan.

Senators have largely focused on concerns that Medicaid provisions in the bill will limit states that expanded or want to expand the shared federal-state program, though with the CBO estimate they’re also expressing worry about what will happen to the older and poorer people in their states who must purchase insurance on their own. Sen. John Thune, a South Dakota Republican, told reporters Tuesday he will seek changes to tax credits in House Republicans’ plan to to help poor people.

“I do think we can tailor the tax credit in a way that makes it more attractive to people and more helpful to people on the lower end and with a phaseout that is a little less steep than what the House has,” Thune said.

Sen. Pat Roberts, a Kansas Republican, told reporters he expects the bill will be changed considerably “not just to suit the Senate, it’s to finally get to final passage and to help people.”

The number of Americans without coverage would rise to 24 million in 2026 under Ryan’s plan, bringing the U.S. uninsured rate to a record 19 percent, according to the nonpartisan CBO.

Older, poorer people will face the steepest decreases in financial help under Ryan’s plan.

A 64-year-old earning $26,500 a year would have a $19,500 premium for health insurance and get a tax credit of $4,900, leaving a bill to pay of $14,600, the CBO estimated. That compares to a $15,300 premium under the ACA with a $13,600 subsidy, leaving the cost to the individual at $1,700.

“It is clear that this bill is not consistent with the repeal and replace principles for which I stand,” Rep. Rob Wittman, a Virginia Republican, said in a statement Monday after the CBO estimate was released. “I do not think this bill will do what is necessary for the short and long-term best interests of Virginians and therefore, I must oppose it.”

Wittman said he supports repealing the health law and will work with colleagues “on legislation that expands choices, increases access, and reduces costs.”

HHS Secretary Tom Price says the CBO left out the effects of the changes HHS can make through the regulatory process. (Photo: Price)

HHS Secretary Tom Price says the CBO left out the effects of the changes HHS can make through the regulatory process. (Photo: Price) 

‘Take a pause’

Insurance premiums will be 15 percent to 20 percent higher over the next couple of years, before the GOP replacement plan goes fully into effect, the CBO estimated. They’d fall after that, thanks to more young people signing up and insurers offering skimpier coverage, the CBO says. In a decade, premiums are estimated to be 10 percent lower than they would have been under Obamacare, the CBO estimated.

“I suspect that the political consequences of those near-term changes mean that the long term will never actually arrive,” Sen. Tom Cotton, an Arkansas Republican, said Tuesday on Hugh Hewitt’s radio show. “That’s why I believe it’s so important that the House take a pause and try to fix some of these fixable problems in their committees, which is the easiest place in Congress to fix them, whereas the Senate floor is the hardest place to fix them.”

Sen. Roy Blunt said Tuesday that he thinks the House will alter the bill before it gets sent to Senate.

“And the plan will be open to change here,” the Missouri Republican said as he headed into a lunch with Health and Human Services Secretary Tom Price.

McCarthy of California said Tuesday on Fox News that he believes the plan will pass in the House. “This is Obamacare gone — we repeal it, we repeal the taxes, and we actually make a system that works,” he said.

Entire plan

House Republican leaders and White House officials, who had been attacking the CBO even before it released its findings, immediately rejected the latest estimates. They said the legislation is only the first of three phases of their health care plan.

Price told reporters that the CBO didn’t analyze the entire plan for health care, including regulatory changes that can be made by HHS.

“We disagree strenuously with the report that was put out,” said Price, who was involved in picking the current CBO director in his previous role as House Budget chairman. “We believe that our plan will cover more individuals at a lower cost and give them the choices that they want, the coverage that they want for themselves and their families.”

But several Senate Republicans said the new estimate shouldn’t be dismissed.

“Rather than attacking the CBO as a way of moving forward, I think the prudent thing for the party to do is to look at the CBO report and see if we can address some of the concerns raised,” South Carolina’s Lindsey Graham said.

Republicans trying to pass the legislation without Democratic support argued that any reduction in the rolls of the insured isn’t as important as what they say will be cheaper coverage. Ryan said there will be a stable transition if the bill is passed so “no one has the rug pulled out from under them.”

Ryan ‘encouraged’

House leadership is “working on getting that consensus” with Republicans in both chambers, Ryan said on Fox News Monday evening. Ryan said he expected the score to show fewer people covered under a plan that doesn’t include a mandate to buy insurance, and he highlighted the deficit reduction and lower premiums in the long term.

“Actually, I think if you read this entire report, I’m pretty encouraged by it, it actually exceeded my expectations,” Ryan told Fox’s Bret Baier Monday.

The legislation, called the American Health Care Act, repeals the ACA mandate that requires many individuals to have insurance or pay a penalty, and the mandate that requires many employers to offer health coverage. It also provides age-based tax credits to help people purchase coverage, though they’re lower than the income-based subsidies offered under current law. The bill will also wind down the ACA expansion of Medicaid. About 12 million people gained coverage in the 31 states that expanded Medicaid.

Two House committees approved the act last Thursday after marathon sessions in which Democrats offered amendments rejected by Republicans. The bill will head next to the Budget Committee on Thursday before being considered by the full House of Representatives.

—With assistance from Steven T. Dennis, Arit John, Toluse Olorunnipa, Erik Wasson, Billy House, James Rowley, Laura Curtis and Terrence Dopp. 

Related:

Cruz pushes ACA repeal gambit that could roil U.S. Senate

House panels approve ACA de-funder drafts

We’re on Facebook, are you?

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.