Centrists push back on new ObamaCare repeal plan
A new proposal from the White House and GOP leaders to revive ObamaCare repeal is facing pushback from centrist Republicans who were already wary of the legislation.
Seeking to win over conservative holdouts, Republicans have talked about redesigning their healthcare bill so that states can apply for waivers on two central ObamaCare rules.
The first regulation, known as essential health benefits, requires insurance plans to cover services such as mental healthcare and prescription drugs. The second, known as community rating, prevents insurers from charging higher premiums to people with pre-existing conditions.
Conservatives have long argued that the two regulations drive up premiums, and some of them have reacted favorably to the waiver proposal.
But the attempt to move the bill further to the right threatens to erode support among moderate members who were turned off by the previous version of the American Health Care Act.
“While we haven’t picked up any votes yet, this concept is already showing signs of losing a ton of them,” a senior Republican source said.
Centrist Rep. Leonard Lance (R-N.J.) indicated he is still a no on the healthcare bill and warned against allowing sick people to be charged more. He said the provision would effectively result in a return to the days before ObamaCare, when people with pre-existing conditions were routinely denied coverage.
“I want to make sure there is no denial of coverage based upon a pre-existing condition,” he said. “I know it’s not directly on point, but I think it has an effect.”
Rep. Tom Reed (R-N.Y.), who supported the GOP repeal bill before it was pulled from the floor last month, called community rating a “very significant reform” made in ObamaCare.
“I appreciate the states’ rights argument but recognize that there’s a reason behind community rating and the benefit that it brings to the insurance reforms,” he told reporters.
House GOP leaders, for their part, are tamping down expectations that there will soon be a breakthrough that would allow them to pass an ObamaCare repeal bill.
“We’re at the concept stage right now,” Speaker Paul Ryan (R-Wis.) told reporters.
Rep. Mark Walker (R-N.C.), the head of the Republican Study Committee, appeared skeptical that any agreement is imminent. He noted efforts to attract conservatives have ended up alienating moderates, while efforts to attract moderates have pushed away conservatives.
“For every adjustment you make one way, it has an equal and opposite reaction the other way,” he said.
Using a Southern expression, Walker said the process is like “squeezing blood out of a turnip.”
After last month’s catastrophic failure, no one has been eager to claim that they are taking the lead on new healthcare negotiations.
House GOP leaders and the Freedom Caucus — the conservative voting bloc that effectively derailed the last version of the bill — said the White House is driving the new effort.
Yet a White House official told The Hill that the process is “being driven from the legislative side.”
It’s clear that Vice President Pence is deeply involved in the talks. He was set to meet with the leaders of different House GOP factions Tuesday night.
Pence was the one who presented the idea of waivers to the Freedom Caucus during a visit to Capitol Hill on Monday.
While Freedom Caucus members said they were encouraged by the offer, none of them have committed support, saying they want to wait to review the legislative text first.
“All of our noes were open-mindedly willing to look at that, and so in doing so, that’s a step in the right direction,” said Rep. Mark Meadows (R-N.C.), the chairman of the Freedom Caucus.
The details of the proposal will be crucial. The White House could try to win over conservatives and moderates by framing the idea in different ways.
Rep. Mo Brooks (R-Ala.), a member of the Freedom Caucus, said he was assured that the Trump administration would be “very receptive” to granting states waivers from the regulations.
But after a White House meeting on Monday, Rep. Chris Collins (R-N.Y.), a member of the centrist Tuesday Group, emphasized that conditions would be put on the waivers.
Rep. Tom MacArthur (R-N.J.), co-chair of the Tuesday Group, said he was “open” to giving states the power to opt out of some of ObamaCare’s insurer requirements but stressed that he has not yet seen the language.
“I would rather trust the states,” he said. “They’re much closer to the people they represent. I think states, in general, understand the needs of their residents more than the federal government.”
Still, MacArthur was already a yes on the bill.
Rep. Charlie Dent (R-Pa.), co-chair of the Tuesday Group, said he’s still a no on the bill and thinks changes to community rating could be hard for some Republicans to accept.
“The changes being suggested aren’t enough to get me to yes. I’m still a no,” Dent told reporters.
“The community rating issue — that could create some challenges for some of our people.”
While repealing community rating would not technically allow insurers to deny coverage to people with pre-existing conditions, experts say it could prevent many sick people from getting coverage by allowing insurers to charge exorbitant rates.
“If there is guaranteed access to insurance without community rating, protections for people with pre-existing conditions are illusory,” tweeted Larry Levitt, a healthcare expert at the Kaiser Family Foundation.
Rep. John Faso (R-N.Y.), a moderate who was undecided on the first healthcare bill, questioned the emerging legislative strategy.
“Hypothetically, if you repealed [the regulations] at the federal level, it would have no impact in New York because of state law,” Faso said. “But I don’t necessarily think that’s an advisable path to winning votes.”
Mike Lillis and Jordan Fabian contributed.
Updated at 7:46 p.m.