President Trump is headed to Capitol Hill on Tuesday to try and rally House Republicans around the health-care bill they are expected to vote on this week, with uncertain prospects of passage. To win the support of conservative holdouts, House Speaker Paul Ryan released 43 pages of amendments to the bill on Monday night, including instant repeal of ObamaCare's taxes on high earners and certain medical companies, allowing states to attach work requirements to Medicaid, adding more restrictions on Medicaid's future growth, and allowing the Senate to increase tax credits for people 50 to 64, if it chooses.
Trump and House conservatives had hammered out many of those provisions in direct negotiations, but one specific amendment is aimed at a handful of Republican moderates from upstate New York. The provision would bar New York from making smaller counties pay for part of the state's Medicaid costs, potentially saving upstate counties some $2.3 billion a year, out of New York's roughly $27 billion Medicaid bill; New York City would still have to pay in. The amendment, which only affects New York, was pushed by Reps. John Faso and Chris Collins, Republicans from upstate New York districts.
"I suggested we put this in," Collins told The New York Times, "and the question that came back was, 'If we do it, can we get the New York votes?'" He said with the amendment, he believes eight of nine members of New York's Republican House delegation will vote yes. "If they did not have the New Yorkers, I'm not sure they could get it over the finish line," Collins said.
It's unclear if those extra votes will push the American Health Care Act over the finish line, or how those changes would be received in the Senate. Republicans sharply criticized Democrats in 2009 and 2010 for secret dealing and targeted provisions to win over on-the-fence members on the Affordable Care Act, with the most infamous example being the Cornhusker Kickback for Nebraska. The Huffington Post has come up with some similarly cutesy nicknames for the New York carveout: "The Buffalo Buyout ― or the Tammany Haul, or the Empire State Earmark, or whatever you may want to call it ― is a recognition that leaders are close, but can't afford to lose votes from moderates."