House GOP leaders do not plan any major changes to their compromise legislation to repeal Obamacare, hoping that more time explaining the plan will lure enough centrist Republicans to support it.
Congress left Friday without a vote on the American Health Care Act, despite a desire from the White House to give President Trump a legislative win before his 100th day on Saturday. Leadership is trying to work on centrist holdouts who are concerned about a new amendment that lets states waive key insurance regulations.
“I think they were closer but not close enough to be certain,” said Rep. Tom Cole, R-Okla., on the chances of reaching the 217 votes needed for the bill to pass. The GOP can afford only about two dozen defections.
A major push by House leaders appears to be explaining to centrists the exact impact of an amendment introduced by Rep. Tom MacArthur, R-N.J., this week.
“There are discussions to try to get people to understand the changes,” Rep. Pat Tiberi, R-Ohio, said Friday.
The amendment itself was a key olive branch to get the conservative Freedom Caucus on board, and it drew a vast majority of the 35-40 member Freedom Caucus who say the regulations are driving up premiums.
But it has led to concerns among members who are worried about the fate of patients with pre-existing conditions, especially centrists who faced angry town halls over their two-week Easter recess.
The compromise lets a state opt out of Obamacare’s mandates that insurers cover 10 essential health benefits such as maternity care, mental health and hospitalization. Another mandate that states could opt out of is the community rating, a price control that forces insurers to charge everybody in an age group the same rate, no matter how sick they are.
While the amendment doesn’t affect the requirement that insurers have to cover people with pre-existing conditions, doing away with community rating could lead to unaffordable health insurance for some patients.
Centrist Rep. Mario Diaz-Balart, R-Fla., said on Thursday that he was previously a “yes” on the version that was pulled from the House floor last month because it didn’t have enough votes. Now he is undecided after he said that the amendment has raised some “red flags” on protections for people with pre-existing conditions.
Rep. Chris Collins, R-N.Y., downplayed the significance of the waiver, especially in liberal states where a governor is unlikely to pursue it.
“I think there is some misunderstanding about how the MacArthur amendment will work,” Collins told the Washington Examiner.
He emphasized it would be hard for a state to even get a waiver if it wanted to, saying there would be “significant scrutiny” of applications.
“It is not going to be any kind of willy-nilly governor saying ‘I am going to eliminate pre-existing conditions’ without having a plan to show [Centers for Medicare and Medicaid Services],” Collins said. The agency would have to approve or reject any waiver within 60 days after confirming it is complete.
Collins said there won’t be any major changes to the amendment, but there could be some small tweaks to entice members. A source familiar with the negotiations agreed that no major changes are planned.
“Anything at this point would be infinitesimally small,” Collins said.
No vote has been scheduled next week on the bill, and senior Republican aides have said they will only bring it up when the votes are locked in.
Rep. Mark Meadows, R-N.C., said he doesn’t think the leadership will bring up the bill if they are a few votes short and attempt to strong arm enough votes on the floor.
“I think that you have to hold the votes knowing that you at least have a good chance for success,” said Meadows, chairman of the Freedom Caucus. “I am not going to question the speaker’s call on not holding the vote.”
The House is in session next week but is in recess the week after.
