The Trump administration’s push to revive the moribund GOP health care proposal has apparently paid some dividends.
The White House and key Republicans in the House of Representatives are reportedly close to an agreement to amend the bill so that states could opt out of two popular Affordable Care Act provisions, including one that requires individual insurance plans to cover 10 “essential health benefits.”
The other provision, known as “community rating,” bars insurers from varying premiums based on health status or medical history. It also requires insurers, under “guaranteed issue” rules, to offer coverage to all who want it.
A proposal from Rep. Tom MacArthur, R-N.J., who leads the moderate GOP Tuesday Group, would allow individual insurers to charge plan members different rates based on their health status.
The proposal was negotiated with Rep. Mark Meadows, R-N.C., who heads the conservative House Freedom Caucus. The caucus announced their support for the deal on Wednesday. That could allow a House vote by Friday on the bill.
House passage of the GOP bill would give President Donald Trump a key legislative success ahead of his 100-day mark this weekend. However, House Speaker Paul Ryan, R-Wis., wouldn’t speculate on timing for a possible vote.
Rep. Mark Sanford, R-S.C., who often sides with the Freedom Caucus, said he will support the revised proposal after “acceptance of the fact that we’re not going to repeal the Affordable Care Act.”
“It’s not a repeal, lets be clear,” Sanford told reporters on Wednesday. “I think it’s very important to be clear with the American public and not to oversell this thing: ‘Oh we repealed it’. No we didn’t repeal the Affordable Care Act. We have trimmed back a couple of its key features...I think that, in short form, it’s the most you can get out of this conference. “
MacArthur’s proposal addresses the Affordable Care Act’s community rating system, in which the entire pool of plan enrollees pays the same premium rates. That spreads the higher costs of sicker plan members among all who buy coverage.
Both guaranteed issue and community rating helped cut the number of uninsured people with pre-existing conditions by 3.6 million, or 22 percent, from 2010 to 2014, according to federal estimates.
Under MacArthur’s proposal, waivers could be granted only to states that participate in a proposed $115 billion risk-sharing pool to help pay medical costs for people with costly pre-existing conditions.
Allowing insurers to set their rates based on health status would mean that serious conditions like cancer and heart disease, along with common ailments like asthma and high blood pressure, could drive up individuals’ cost of coverage. That could make insurance unaffordable and cause many to drop it.
That would only add to the estimated 24 million people expected to lose coverage under the GOP bill over the next decade, said a statement by Bruce Siegel, president and CEO of the trade group America’s Essential Hospitals, comprising those that treat a disproportionate share of impoverished patients.
“This latest version of the AHCA is not an improvement. It’s simply bad policy that will cut a lifeline of health care for millions of Americans,” Siegel’s statement said.
Rep. Tom Reed, R-N.Y., a moderate Tuesday Group member, said he is inclined to support the amendment, but he hadn’t yet made up his mind on the full legislation, citing concerns about provisions dealing with with pre-existing conditions.
“I’m very sensitive to that, making sure that it’s there in form and substance,” Reed said.
MacArthur’s amendment also lets states seek federal approval to waive Obamacare’s essential coverage requirements and set their own coverage mandates.
The Trump administration tried earlier this month to get House Republicans to adopt similar proposals after a full House vote on the GOP health bill was scrapped last month due to a lack of support.
Ryan called the measure “very constructive” on Wednesday. He said it would lower premiums and give states more flexibility.
Because premiums for young and healthy people would likely decline under the proposed amendment, Republicans expect the measure to spur more people to buy coverage.
Ryan said he expects the amendment to get the fractured Republican caucus closer to consensus, but he would not say when he expects the bill to get another full vote in the House.
“We’ll see,” he said. “We’ll vote on it when we get the votes.”
After voting more than 50 times to repeal the ACA, Sanford said House Republicans realized “at the end of the day, there wasn’t the will” to repeal the law. “And so, what you then say is ‘OK what’s the most you can get within this context of non-repeal?’ And we ultimately thought that this was it,” Sanford said.
In a statement, House Democratic Whip Steny Hoyer, of Maryland, said the proposal would allow insurers to discriminate against people with pre-existing conditions, “making it substantially the same bill that House Republican leaders could not secure the votes to pass last month.”
Older people and sicker people, including those with pre-existing conditions, would likely have to pay more for health insurance under the proposal. That could leave many unable to afford it.
Some 52 million working-age adults have pre-existing medical conditions that would likely have left them unable to get health coverage before the Affordable Care Act, according to an analysis by the nonpartisan Kaiser Family Foundation.
“Bringing their catastrophic bill back, repackaged but unchanged, will not make it any more likely to pass; nor will it make it any less dangerous to the health of the American people,” Hoyer said. “I urge the speaker and majority leader to keep their TrumpCare bill off the House Floor.”
Rep. Tom Cole, R-Okla., said many House Republicans still hadn’t seen the text and the details of the proposal but were encouraged by a discussion of the measure Wednesday.
Rep. Chris Collins, R-N.Y., a member of the Tuesday Group, said the MacArthur proposal put pressure on all members to vote for the bill.
“I’m telling any and every member that we need to get this done,” Collins said. “We made a promise when we campaigned. It’s a promise that we made and it’s reasonable. Let’s get it done.”
Reed rejected any notion of added pressure to support the measure. “It’s just a matter of looking at the legislative text and determining what works for (lawmakers) their districts. At the end of the day, the closer we get to 216, that’s a win for the American people.
Asked about the likelihood that the Senate would strip the proposal out, Collins said, “Let the Senate do their job. We’re going to do our job.”
But the bill may, in fact, be “going nowhere” in the Senate because the new language would likely run afoul of the Byrd rule, meaning it would require 60 votes in the Senate to pass, said Matt House, a spokesman for Senate Democratic leader Chuck Schumer of New York.
“Once again, House Republicans have made their bill worse for the health of the American people in order to buy off the Freedom Caucus and other conservatives,” House said. “There will not be 60 votes for a bill that drives up premiums and causes millions of people to lose their health insurance.”
An earlier version of this story incorrectly said Rep. Mark Sanford, R-S.C., was a member of the moderate Tuesday Group. Sanford, a conservative, often aligns with the Freedom Caucus.