The House Republican health care bill cleared another hurdle on Thursday, but one of the most fiscally conservative GOP lawmakers says the bill will never pass unless it acts to immediately reduce the cost of coverage and includes repeal of Obamacare’s burdensome regulations.

The House Budget Committee approved the American Health Care Act, 19-17.  Three Republicans voted against it, including Rep. Dave Brat, R-Va.

“The budget committee went forward with it, but some of the guys are getting promises that we’re going to have some fixes and some fairly significant fixes going forward,” said Brat, who believes the Republicans are heading toward disaster on their present course, largely because they don’t address health care costs effectively.

“Both conservative and liberal think tanks and health experts agreed that the current House bill maintains the current structure of Obamacare,” said Brat.  “You keep the individual exchanges. You keep the individual market and you keep the insurance regulations, so I don’t know how anyone expects the price of health care to go down.”

And without lower costs, Brat says Republicans are walking into a political buzz saw with no upside.

“That’s the big thing we have to fix and we all want Trump to be successful.  For him to be successful, we have to make those changes or in a few years we’ll be in another death spiral,” said Brat.  “It’s fairly simple.  Either you lower the price of this thing so people can afford it or else you’re going to pay the price politically.”

He says the key to driving costs down is to address insurance regulations, a priority President Trump has been pushing for months.

“Our leadership bill has prices going down 10 percent after three years.  So we’ve got price increases coming.  We’ve got to make sure that does not happen.  The biggest way you can prevent that is to get at the insurance regulations,” said Brat.

There’s also the issue of choosing what’s in a plan.  For example, Brat notes that because of the many requirements Obamacare mandates in every approved health plan, it’s impossible for young, healthy people to buy low-cost, high-deductible catastrophic plans.

GOP leaders currently argue that market-based reforms would be included in separate legislation from the first bill which deals mainly with taxation and mandates.  That’s the third phase of replacing Obamacare.  They also say regulatory repeal is not in the bill because Health and Human Services Secretary Tom Price can roll those back unilaterally.  That is phase two.

Brat is not impressed.

“The problem there is it’s not permanent.  We’ll have this kind of bumper pool every four years, when you switch administrations you’ll change health care for the whole country.  We want that that bucket number two, that Price is going to take care of, to be put into the bill itself,” said Brat.

He says allowing greater competition for coverage and including regulatory reform in the bill could salvage the legislation for many conservatives.

“I think if leadership goes forward with that and pushes it over to the Senate, that’ll get a lot of people to ‘yes.’  That could be the sweet spot,” said Brat.

How will this play out in the coming weeks?  Brat says Trump is the key.

“I don’t think we’re even close to having the votes, so Trump will come in and negotiate and put his foot down on a system that he wants.  He wants to increase competition across state lines and to reduce the costs for everybody so it’s affordable.  If we can get it done in a month or two, it can be signed, sealed and delivered if we can zap these insurance regulations,” said Brat.

He says those components would also allow Republicans, who ran on repealing and replacing Obamacare, to make good on their promises to the American people.

“We can put [a bill] together brick by brick but the key is you’ve got to start out with the glue.  Repeal, that was the promise.  Then move forward from that and build a scaffolding up from there,” said Brat.

“You want to start with free markets and then add a safety net.  You don’t want to start with socialism and then promise free markets later.  That never happens,” said Brat.

So why haven’t these ideas been in the bill from the start?  Brat suspects quite a few GOP senators are looking to dodge controversial votes.

“The Senate has become kind of a high noon tea society over there.  They’re not taking tough votes.  They don’t want this bill to come over in the first place.  I think they’re using that as a way to duck.  Even our side uses that as a way to duck from pushing through what we have to get through,” said Brat.

Brat also rejects the leadership’s argument that market reforms and regulatory repeal can’t be included in a reconciliation process.  He says that’s just not true.  He says the Senate can simply vote to determine if a provision is tax or budget-related.

He says getting this major overhaul done and done right is a matter of political will, and adds that not is the time to demonstrate that will.

“Let’s roll the TV cameras in there.  Let’s put that live in front of the American people so they can see the process of their own government at work for them, and I think we’ll have a big win,” said Brat.