Conservatives endorse revised health care plan
Some centrists still wary
The hard-line conservatives who helped sink Republicans’ first Obamacare repeal attempt reversed course Wednesday and officially endorsed the latest plan designed to slash costs for healthy Americans, giving congressional leaders a critical boost as they seek a do-over.
The House Freedom Caucus’ support will heap pressure on Republican centrists, who also resisted the first go-around last month but who will now be called upon to get the repeal bill over the finish line.
“While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health care costs,” the Freedom Caucus said in a statement.
The endorsement is the direct result of a proposal brokered by Freedom Caucus Chairman Mark Meadows of North Carolina and Rep. Thomas MacArthur, a centrist from New
Jersey. It would allow states to opt out of parts of Obamacare requiring insurers to cover “essential” benefits such as maternity and mental health care or prescription drugs.
States also can waive rules requiring insurers to charge healthy consumers the same amount as sicker consumers, so long as states set up risk pools to subsidize those priced out of the market because insurers cannot deny people with pre-existing medical conditions.
The deal won immediate praise from some of the conservative pressure groups that helped sink the repeal bill in March.
But it faced immediate criticism from Democrats, who said the language would give a special carve-out to members of Congress, allowing them to keep their high-coverage plans while letting states strip down coverage for their residents.
Republican aides said they had to include the exemption to satisfy Senate rules because of the complicated budget process Republicans are using to pass their repeal bill without facing a Democratic filibuster.
“Congressman MacArthur does not believe members of Congress or their staff should receive special treatment and is working with House leadership to make absolutely clear that members of Congress and staff are subject to the same rules, provisions and protections as all other Americans,” MacArthur spokeswoman Camille Gallo said.
Aides said Republicans would push for legislation that fixes the problem alongside the repeal-and-replace bill.
“That sidecar bill needs to be voted on 15 minutes afterward or it’s all BS,” said Robert Laszewski, a health policy consultant in Virginia.
He said it would be outrageous for members of Congress to ensure their health care benefits are more robust than everyone else’s.
Democrats said the congressional carve-out was just one problem with the bill, which they said eviscerated the protections written into Obamacare.
“If House Republicans are afraid of TrumpCare for themselves, they have no right to force it on hardworking American families,” said House Minority Leader Nancy Pelosi, California Democrat.
Democrats have been in lockstep opposition to the Republican efforts from the beginning, saying the solution to Obamacare’s problems is an infusion of more government funding and a larger federal role in the health care market.
Without Democrats, Republicans need to have near unanimity. It was a lack of support within the party that forced House leaders to pull their bill from the floor.
Now, those leaders are hopeful that problem has been resolved.
“We think the MacArthur amendment is a great way to lower premiums, give states more flexibility while protecting people with pre-existing conditions. Those are the three things we want to achieve,” said House Speaker Paul D. Ryan, Wisconsin Republican.
The Freedom Caucus said at least 80 percent of its roughly 30 members support the latest plan, which is enough to earn a caucus endorsement.
Mr. Ryan and other senior Republicans stopped short of saying they have the 216 votes needed to pass the bill.
The biggest hurdle now could be centrists. Multiple moderates from the Northeast — including Rep. Charles W. Dent, Pennsylvania Republican and an influential member of the Tuesday Group — have said the changes don’t assuage their concerns about the underlying bill. The Congressional Budget Office estimates that the plan would result in 24 million fewer people holding coverage a decade from now.
“Too many people have viewed health care reform as a speed bump on the road to tax reform,” Mr. Dent said.
Rep. Tom Cole, Oklahoma Republican, said holdout moderates probably numbered in the “midteens.”
“You might be able to get there without them, but you want something that everyone can feel comfortable voting for,” he said. “Leadership certainly is not trying to deal anybody out of the game.”
The changes were negotiated in part by Vice President Mike Pence, who shuttled back and forth to Capitol Hill to find a way forward.
Rep. Warren Davidson, Ohio Republican and member of the Freedom Caucus, said the MacArthur changes and an amendment by Rep. Gary J. Palmer, Alabama Republican, that freed up $15 billion for high-risk pools brought him from “no” to “yes.”
Some conservatives still aren’t sold. Rep. Walter B. Jones, North Carolina Republican, said he applauds Mr. MacArthur’s work but wants to see the final product around it.
“I think what’s he’s doing is yeoman’s work and he’s doing a great job, and I think it does help the bill,” he said. “But until you see the whole bill, I just don’t know how you can say I like just one part of it.”
House Freedom Caucus Chairman Mark Meadows helped broker the health care deal.