A united Republican bill to repeal and replace Obamacare appears more and more out of reach after an Easter recess full of rowdy town halls, which have emboldened centrist Republicans to oppose an aggressive repeal of Obamacare being pushed by conservative Republicans and the White House.
The key sticking point for Republicans is which Obamacare regulations states would be able to ignore under the final bill. The conservative House Freedom Caucus wants to let states opt out of a health insurance price control called "community rating" and a rule mandating essential health benefits, because they say those provisions lead to higher costs.
But centrists are balking, particularly about the community rating, which forces insurers to charge people of the same age the same rate so that sicker people do not have to pay more.
The town halls being held during the Easter recess seem to be furthering the divide between the two factions, with the fight over pre-existing conditions being the main dispute. While people with pre-existing conditions could still get coverage, without community rating insurers could charge them exorbitant prices.
Conservatives say that high-risk pools can act as a safety net for those patients. However, centrists worry that the conservative plan would erode the Obamacare benefit, leaving them to face soaring costs.
Two GOP centrists, Reps. Greg Walden of Oregon and Leonard Lance of New Jersey, made it clear to people in their respective town hall meetings that they oppose any effort to remove the current protections for people with pre-existing conditions such as diabetes and cancer.
"We are not going back to the days where you could underwrite where it becomes so expensive that you can't afford it," Walden told his constituents at a town hall last week, referring to community ratings.
Lance also said during his town hall that he was against any change that would gut protections for pre-existing conditions.
"You have my commitment that I will not vote for any bill that in any way lessens the requirement of no denial of coverage based upon a pre-existing condition," said Lance, who was opposed to the GOP's proposal, the American Health Care Act.
Members of the Freedom Caucus, who are leading the charge to let states opt out of the Obamacare requirements, say they aren't against coverage guarantees for people with pre-existing conditions. Vice President Mike Pence put together the measure that would let states opt out of some Obamacare regulations.
"The Freedom Caucus has never opposed pre-existing conditions, ever," Rep. David Brat, R-Va., told the Washington Examiner.
Other Freedom Caucus members agreed.
"We will continue to cover pre-existing conditions," said Rep. Joe Barton, R-Texas, during a town hall last week. "The repeal bill does not do away with that," Barton added referring to the American Health Care Act, which he supported.
Rep. Justin Amash, R-Mich., a key opponent of the American Health Care Act, agreed that those with pre-existing conditions need a safety net.
That safety net, pushed by the Freedom Caucus, would be high-risk pools that states would set up and insurers would help fund, a last-minute amendment to the American Health Care Act.
The measure, however, allocates only $15 billion for the pools, which experts said isn't nearly enough. The amendment also would allow states to use whatever money is leftover from a $115 billion stability fund being set up to prop up individual markets.
But centrists are worried that people with pre-existing conditions would end up paying more for insurance, which would effectively hurt those people.
The town halls are being held at a pivotal juncture in the Obamacare repeal negotiations.
The bill was pulled last month because it didn't have enough votes, as both members of the Freedom Caucus and centrist Tuesday Group balked at the legislation, albeit for different reasons. The caucus wanted to repeal key Obamacare insurer mandates and centrists were concerned about patient coverage, positions that haven't changed despite weeks of negotiations.
A House Republican leadership aide this week played down any divisions, saying that members are continuing to talk to get to a plan that most House Republicans can support.
Brat downplayed the anger Republicans are facing at town halls, saying that the anger is from Democratic grassroots activists and liberal groups such as Indivisible, which is coordinating people to attend the town halls.
"Most of these people are upset that Trump won," he said. "There is a ton of activism out there."