An eleventh-hour deal has renewed momentum for House Republicans working to repeal and replace Obamacare, as leaders Wednesday furiously lobby undecided or skeptical lawmakers on the plan that has been teetering on the brink of collapse.
House leaders have made clear that if everything goes their way, their preference is to have a vote Thursday. But they won’t call a vote unless they believe it will pass.
Vice President Mike Pence is on Capitol Hill. Members have been walking in and out of the speaker’s office all day.
The change in mood comes after GOP Reps. Fred Upton and Billy Long met with President Donald Trump at the White House and flipped their votes from “no” to “yes.” Trump committed to backing an amendment spending $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions.
The new “yes” votes mark an incremental but symbolically important victory for the White House and Republican leaders, who have been trying without success for weeks to revive a health care bill that was pulled from the House floor in March.
Other than Long and Upton, there have not been major switches from the “no” to “yes” category, but several undecided members are seemingly open to the new changes.
The focus is on moderate lawmakers concerned the GOP bill will erode too many protections in Obamacare. As originally introduced, the bill would leave 24 million fewer people insured by 2026 than under Obamacare, the non-partisan Congressional Budget Office said.
But the House Freedom Caucus, a group of conservatives who helped scuttle the previous bill in March, now supports the legislation.
Importantly, the Freedom Caucus continues to back the bill Wednesday, even with the new spending being added.
Freedom Caucus Chairman Mark Meadows said only one member of the group opposes the bill. “We’re not going to lose any votes because of it,” he said.
The situation remains extremely fluid.
The future of the bill “as uncertain as we’ve seen it,” a Republican involved in the health care talks said.
Around the same time that Upton and Long unveiled their moves to “yes,” their colleague, Rep. Carlos Curbelo of Florida, declared on Twitter that he opposed the bill.
“I just reiterated to @HouseGOP leaders that #AHCA in its current form fails to sufficiently protect Americans with pre-existing conditions,” Curbelo said.
New Jersey Rep. Leonard Lance, a moderate Republican opposed to the bill, also told CNN Wednesday morning that Upton’s proposed change would not sway him to support the health care legislation. Lance also noted that he has not heard from Trump or Vice President Mike Pence in several weeks.
Moderate Reps. Charlie Dent, Frank LoBiondo and Jaime Herrera Beutler say they still oppose the bill even with the Upton amendment.
Full court press from Trump
The White House is in a full-court press to rally GOP support to repeal and replace Obamacare. Trump and House leaders failed last week to garner enough support to hold a vote on the bill ahead of the President’s symbolic 100th day in office.
The President called about a dozen wavering Republican lawmakers throughout the day Tuesday, urging them to back the health care bill, a White House official said.
It’s very much an open question, though, how helpful this may be, because the President often is suggesting on some calls he’s more open to changing the bill to win over moderates, each call creating a new dynamic.
But he is urging them to pass the bill, declare victory and move on.
Upton and Long were joined by GOP Reps. Greg Walden and Michael Burgess in their meeting with Trump Wednesday morning.
Upton had rocked Capitol Hill Tuesday by publicly coming out against the GOP health care bill.
His amendment would add $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions in states that seek waivers under the Republican legislation, two sources told CNN. The measure already included $130 billion in the fund.
How to handle coverage for Americans with pre-existing conditions has been a struggle for Republicans seeking to fulfill their longstanding desire to repeal Obamacare. A major pillar of the law is the ban on insurance companies from discriminating against people based on their past medical conditions.
For decades prior to the enactment of the Affordable Care Act, many Americans were unable to even afford or obtain insurance because of their past medical history. As Obamacare has shifted that norm, Republicans have grown increasingly careful in recent years to say they would not repeal protections for people with pre-existing conditions, wary of being branded the party that wants to take that protection away.
High-risk pools
High-risk pools have long been a favorite tool of Republicans, but they have a very checkered past. They were typically severely underfunded, charged participants high premiums, excluded coverage of pre-existing conditions initially and had waiting lists for enrollment.
Some 35 states ran high risk pools prior to Obamacare. In 2011, states had to kick in $1.2 billion to cover 226,000 people enrolled in the programs.
Upton’s plan likely wouldn’t make much of a difference.
“You just aren’t going to cover many people with $8 billion over five years,” said Karen Pollitz, senior fellow at the Kaiser Family Foundation.
What’s in the bill?
The GOP health care bill would eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan would provide Americans with refundable tax credits based mainly on age to purchase health insurance.
The legislation would also allow insurers to charge higher premiums to those in their 50s and early 60s, compared to younger consumers.
It would also significantly curtail federal support for Medicaid and allow states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults, and those that hadn’t expanded would be immediately barred from doing so.
And it would allow states to relax some key Obamacare protections of those with pre-existing conditions, which are among the health reform law’s most popular provisions. States could apply for waivers to allow insurers to offer skimpier policies that don’t cover the 10 essential health benefits mandated by Obamacare. Also, insurers would be able to charge higher premiums to those with medical issues if they let their coverage lapse. States requesting waivers would have to set up programs — such as high-risk pools — to protect insurers from high-cost patients.
However, the GOP bill doesn’t touch one another beloved piece of Obamacare — letting children stay on their parents’ insurance plans until the age of 26.
