ObamaCare replacement deal hits major speed bumps

House Republicans are throwing cold water on hopes there will be a vote next week on a revived ObamaCare repeal-and-replace bill. 

Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, and Rep. Tom MacArthur (R-N.J.), co-chairman of the centrist Tuesday Group, are nearing a deal on changes to the bill, and the White House is eager for a victory before President Trump’s 100th day in office, on April 29. 

But GOP aides and some lawmakers say it seems doubtful the deal, as presented by MacArthur, could win approval in the House.

They also note that there is not even legislative text yet to mark a deal, which makes the prospect of holding a vote next week even more unlikely.

ADVERTISEMENT
“The question is whether it can get 216 votes in the House, and the answer isn't clear at this time,” said a senior GOP aide, referring to the number of votes likely necessary to pass the legislation.

“There is no legislative text and therefore no agreement to do a whip count on.”

“I don’t know that the state of play has really changed over the recess,” said another House GOP aide. 

A White House aide also said they are “still in the same place we’ve been” with no timetable or set date for a vote. 

The changes being discussed would allow states to apply for waivers to a core ObamaCare provision, known as community rating, that stops insurance companies from raising premiums based on individuals' health, as long as the states also offered high-risk pool coverage or participated in the federal pool. 

Waiving that provision would mean insurers could go back to the days of charging people with much higher premiums based on their health, often putting coverage out of reach. Conservatives argue funding for high-risk pools could fill the gap, but opponents say high-risk pools were underfunded and did not work before ObamaCare. 

The proposed changes would also allow states to waive ObamaCare’s requirement that insurers offer certain benefits, including mental healthcare and prescription drugs. 

While the changes could win over some conservatives in the Freedom Caucus, aides expressed doubts it will win over a number of centrists, who are critical to getting a bill through the House in the face of unanimous opposition from Democrats.

MacArthur is a centrist, but he backed the original ObamaCare replacement bill pulled from a scheduled floor vote last month. Centrists were fleeing that bill as it moved toward a vote.

“There's no deal,” said an aide to one moderate House GOP lawmaker.

“I wouldn't be surprised if they started to lose more moderates” because of the new changes, the aide added.

Sources said the agreement has largely been between Meadows and MacArthur, and much of the rest of the GOP conference has not been involved in the talks.

Rep. Dan Donovan (R-N.Y.), a centrist lawmaker, told The Hill Thursday that he is still opposed to the bill despite the changes.  

“None of the changes addressed the concerns I had with the original proposal,” Donovan said.

He and other moderates are concerned that the healthcare bill could shift more costs onto older people. He also worries about people who received coverage through ObamaCare’s Medicaid expansion.

He also took issue with an amendment to the bill that exempted all New York counties - except New York City - from making Medicaid payments to the state.

“We have to figure out how to help those people who were harmed by the ACA while at the same time not hurting people who were helped by it,” he said.  “The amendment today to the original plan doesn’t address any of those things that are my concern.”

Illustrating the uphill climb for the new changes, many Republican lawmakers have spoken in favor of keeping ObamaCare protections for people with pre-existing conditions. 

Rep. Patrick McHenry (R-N.C.), the chief deputy whip, called similar changes earlier this month a “bridge too far for our members.”

A study from the liberal Center for American Progress, released Thursday, finds that repealing community rating would lead to sharp premium increases for sick people, such as roughly $4,000 for those with asthma or as much as $71,000 for those with severe cancer. 

Republicans have said they will work on healthcare once they return from a two-week recess Monday, but must first deal with a looming deadline to pass a spending bill to avoid a government shutdown. 

Still, Speaker Paul RyanPaul Davis RyanDem: Ex-lawmaker tried to pin me to elevator door and kiss me Two months later: Puerto Rico doesn’t have power, education or economy running again On Capitol Hill, few name names on sexual harassment MORE (R-Wis.) said Wednesday that Republicans are putting the “finishing touches” on their repeal-and-replace bill. 

“We’re in the midst of negotiating sort of finishing touches, because our members want to make sure that we lower premiums,” Ryan said. “We’re very close, and it’s basically, make good on the promises that we made … It’s just going to take us a little more time to make good on that.” 

President Trump said Thursday that he wants a vote on a healthcare bill soon, though he did not definitively call for one next week, saying he wants a vote "next week or shortly thereafter." 

"We’re doing very well on healthcare," he said at a joint press conference with Italian prime minister Pauolo Gentiloni. "We’ll see what happens."

- Updated at 4:31 p.m.