New Oba­macare re­peal bill aims to unite Repub­li­cans


House Repub­li­can lead­ers re­vived their Oba­macare re­peal bill Thurs­day, mod­i­fy­ing the plan to earn the sup­port of wary con­ser­va­tives and set­ting the table for a show­down when Congress re­turns from a two-week spring break.

Just weeks af­ter they bun­gled their first at­tempt at pas­sage and de­clared Oba­macare the law of the land for the fore­see­able fu­ture, Repub­li­can lead­ers re­versed them­selves again, say­ing they think they have found a way to en­tice the war­ring fac­tions within their party back to the table.

Their lat­est pro­posal calls for the gov­ern­ment to spend an ad­di­tional $15 bil­lion to sub­si­dize pre­mi­ums for sicker cus­tomers, al­low­ing in­sur­ers to charge less for health­ier peo­ple.

“This brings us closer to the fi­nal agree­ment that we all want to achieve,” House Speaker Paul D. Ryan, Wisconsin Repub­li­can, said at his weekly press

con­fer­ence. He was joined by 20 or so law­mak­ers from the dis­parate Repub­li­can fac­tions, a bit of theater de­signed to ex­ude party unity.

Law­mak­ers held up the mea­sure as a hope­ful — if in­cre­men­tal — devel­op­ment af­ter the lat­est round of talks failed to bridge rifts within the Repub­li­can Party over a way for­ward.

“Re­peal and re­place of Oba­macare is not dead,” said Rep. Mimi Wal­ters, Cal­i­for­nia Repub­li­can.

For now, Repub­li­cans will leave Capi­tol Hill with noth­ing to show their con­stituents on health care.

“At this point, I am will­ing to stay to get it done, but I am not concerned. My dis­trict loves me,” said Rep. Mark Mead­ows, North Carolina Repub­li­can and chair­man of the Free­dom Cau­cus, which an­gered Pres­i­dent Trump by with­hold­ing its sup­port for the Oba­macare re­peal bill.

Rac­ing to­ward a self-im­posed dead­line last month, Repub­li­cans tried to pass a bill that would have re­placed Oba­macare’s gen­er­ous sub­si­dies with a Repub­li­can­writ­ten tax en­ti­tle­ment de­signed to help peo­ple af­ford cov­er­age if they don’t have plans through their em­ploy­ers. The bill also would have re­struc­tured Med­i­caid and can­celed Oba­macare’s in­di­vid­ual man­date.

Con­ser­va­tives said the bill was too sim­i­lar to Oba­macare, while mod­er­ate Repub­li­cans balked at an anal­y­sis that showed some 24 mil­lion fewer peo­ple would have cov­er­age un­der the Repub­li­can plan a decade from now.

Repub­li­cans were 10 to 15 votes shy of build­ing a ma­jor­ity and pulled the bill from the floor, ad­mit­ting to an em­bar­rass­ing de­feat.

Along the way, they even man­aged to make Oba­macare look good. Polling sug­gests the Af­ford­able Care Act is more popular than ever. Gallup says a ma­jor­ity of Amer­i­cans sup­port the law — a first since the com­pany started ask­ing about it in 2012.

Three in five peo­ple told the non­par­ti­san Kaiser Fam­ily Foun­da­tion that Mr. Trump and con­gres­sional Repub­li­cans will be re­spon­si­ble for any health care prob­lems now that they are in charge.

Rep. Chris Collins, New York Repub­li­can, said the fail­ure to act on health care does not send a pos­i­tive sig­nal on how House Repub­li­cans will han­dle other is­sues, in­clud­ing tax re­form. He also said mem­bers of the House Free­dom Cau­cus will re­gret their early op­po­si­tion.

“What are they go­ing to tell their con­stituents in six months or next year? Be­cause they are go­ing to wear it,” he said. “They can try like heck to point fingers any which way they can. Those fingers are point­ing back at them­selves.”

Now, the hold­outs are pon­der­ing the changes.

Free­dom Cau­cus mem­bers say the White House could get most of them to ap­prove a bill by al­low­ing states to seek waivers from reg­u­la­tions that re­quire health in­sur­ers to cover a min­i­mum set of ben­e­fits, charge sicker con­sumers the same amount as healthy peo­ple in a given ge­o­graphic area and of­fer poli­cies re­gard­less of health sta­tus.

“If those of­fers that were made over the last cou­ple days ac­tu­ally ap­pear in the leg­is­la­tion, the ma­jor­ity if not al­most all of the Free­dom Cau­cus will vote for this bill,” Mr. Mead­ows said Thurs­day dur­ing a Politico Play­book in­ter­view.

House Repub­li­cans pledged to avoid changes that would force sicker con­sumers to pay more or roll back pro­tec­tions for peo­ple with pre­ex­ist­ing con­di­tions, how­ever, so the Free­dom Cau­cus’ de­mands are a tough sell among the rest of the con­fer­ence.

They also might spook Se­nate Repub­li­cans, who can­not af­ford to lose more than two votes from their 52-seat ma­jor­ity.

The Free­dom Cau­cus says its ideas can work with the type risk-pool­ing pro­posed Thurs­day by Rep. Gary J. Palmer of Alabama and Rep. David Sch­weik­ert of Ari­zona. Their four-page amend­ment would give the Health and Hu­man Ser­vices De­part­ment wide lat­i­tude over how to dis­perse the $15 bil­lion to in­sur­ers, in­clud­ing which pa­tients would be cov­ered.

The fed­eral gov­ern­ment would over­see the pro­gram for three years be­fore it is handed off to the states.

Mem­bers ap­plauded the idea in prin­ci­ple — Repub­li­cans have long em­braced high-risk pools — though they said they needed time to digest the changes in their home dis­tricts.

“We’re mak­ing progress,” said Rep. Pa­trick J. Tiberi, Ohio Repub­li­can. “We made progress in this Palmer amend­ment; we’ll con­tinue to try to make progress when we get back. We’re go­ing to be talk­ing over re­cess.”

Some Repub­li­cans said they are ready to cut their re­cess short if a deal is struck.

“If we get white smoke, we’ll all be ad­vised of that and act ac­cord­ingly,” said Rep. H. Mor­gan Griffith, Vir­ginia Repub­li­can. “I don’t know that it’s a prob­a­bil­ity, but it’s al­ways a pos­si­bil­ity.”

Democrats carped from the side­lines, say­ing Repub­li­cans are cast­ing about for an­swers.

“There was no vet­ting at all, no process what­so­ever. Just a cou­ple of good ol’ boys with a type­writer say­ing, ‘Maybe this will work,’ ” Rep. James P. Mc­Gov­ern, Mas­sachusetts Demo­crat, told the Rules Com­mit­tee. “I guess what my Repub­li­can friends want is to have some­thing to point to be­fore the two-week re­cess. But this isn’t a so­lu­tion.”

Pol­icy an­a­lysts said Repub­li­cans are un­der­es­ti­mat­ing the cost of sub­si­diz­ing pools of high-risk con­sumers.

Thurs­day’s pro­posal “could be very help­ful to re­duc­ing in­sur­ance pre­mi­ums and keep­ing in­sur­ers in the game, if it were ad­e­quately funded,” said Ti­mothy Jost, a law pro­fes­sor at Washington and Lee Univer­sity who closely tracks the health care de­bate. “It isn’t at this level.”

Larry Le­vitt, a se­nior vice pres­i­dent at the Henry J. Kaiser Fam­ily Foun­da­tion, tweeted that “$15 bil­lion over 9 years is def­i­nitely not enough to make a mean­ing­ful dif­fer­ence in pre­mi­ums or mar­ket sta­bil­ity.”

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