Fractured House GOP still can’t agree on Obamacare replacement

Many Affordable Care Act supporters are closely watching negotiations with House Republicans and the Trump administration on a new proposal to replace the health care law.
Many Affordable Care Act supporters are closely watching negotiations with House Republicans and the Trump administration on a new proposal to replace the health care law. The State

Negotiations to revive the failed GOP health care legislation have hit a major, probably lethal, snag.

Embarrassed and frustrated by last month’s collapse of their effort to repeal and replace Obamacare, conservatives this week launched a last-ditch effort to revive the legislation.

Despite late-night meetings Monday and Tuesday with fellow Republicans, including GOP leaders in the House of Representatives and Vice President Mike Pence, they’re up against familiar obstacles that could doom the effort for the year.

Conservative interest groups are on the warpath, charging the new ideas don’t go far enough to destroy the 7-year-old Affordable Care Act.

On the other end of the GOP political divide, moderate House Republicans are withholding support for the new White House-backed changes. They fear the revisions would jeopardize the health law’s requirement that individual insurers cover people with pre-existing medical conditions.

House Speaker Paul Ryan said that “Obamacare is the law of the land,” after the GOP health care plan was pulled on Friday. “We came really close today, but we came up short,” Ryan said.

An estimated 133 million Americans under age 65 have pre-existing conditions that would have kept them from getting individual insurance or required them to pay much higher rates prior to 2014, when the ACA’s new coverage protections were implemented, according to federal estimates.

Conservative activists Wednesday blamed at least five members of the centrist House Tuesday Group for the impasse. Conservatives complained the moderates were not eager to allow states to opt out of two popular ACA provisions: One would require all plans to cover 10 “essential health benefits” and another would bar insurers from charging sick people more for coverage than healthy people.

Although both rules increase the cost of individual insurance, patient advocates say they ensure that coverage is standardized, thorough and accessible to those who need it.

Michael Needham, chief executive officer of Heritage Action, a leading conservative group, was sharply critical Wednesday of GOP centrists Reps. David Joyce of Ohio, Leonard Lance of New Jersey and Patrick Meehan of Pennsylvania. They “were standing in the way of legislative compromise that is being pushed by the White House and which would get overwhelming support in the Republican conference.”

“They’re opposed because they don’t want to repeal Obamacare,” Needham told reporters on a conference call.

He said lawmakers should begin their congressional recess, scheduled to start Thursday afternoon, and vote on the legislation when they return.

The conservative Club for Growth piled on, accusing Republican moderates of torpedoing a potential deal.

“The left wing among House Republicans doesn’t want to compromise or keep their pledge to voters to repeal Obamacare,” said Club for Growth President David McIntosh.

Moderates, in turn, blamed conservatives for constantly altering their demands.

“Repeal and replace,” said Lance. “I have never campaigned on a mere repeal, ever.”

Rep. Chris Collins, R-N.Y., one of President Donald Trump’s closest House allies, said Heritage “is about one thing: raising money. They raise money on controversy. The more controversy, they blast out an email, they gin up their supporters. They cash the checks and they move on.”

Conservatives were adamant they were negotiating in good faith. Rep. Mark Meadows, R-N.C., who chairs the House Freedom Caucus, remained optimistic, given continuing talks.

“I’ve found that as long as conversations are ongoing, decisions are not far off,” he said.

Ironically, it was opposition by the Freedom Caucus that first forced House Speaker Paul Ryan, R-Wis., to cancel a March 24 vote on the original GOP legislation. The group said that proposal was too much like the ACA and didn’t eliminate enough Obamacare insurance regulations.

This time, however, Needham said the Freedom Caucus had agreed to major concessions in order to secure Tuesday Group support. Originally, the new White House plan called for eliminating nearly all the so-called Title 1 insurance regulations under the ACA. Those regulations ban lifetime benefit limits on individual coverage, require all plans to cover the essential health benefits and, in most cases, bans insurers from charging higher rates to sick people.

The standardized rates are made possible by a concept known as “community rating,” in which everyone in a pool of enrollees pays the same premium so that the costs of sicker, more expensive plan members are spread across all those who buy coverage. The ACA’s modified community rating allowed for rates to vary based only on age, geographic medical costs and tobacco use.

Instead of an outright repeal of the Title 1 provisions, the Freedom Caucus agreed to allow states to seek federal waivers to opt out of the Title 1 regulations requiring essential benefit coverage and community rating.

Others countered that without the mandatory coverage of “essential health benefits,” the law’s limits on out-of-pocket spending would be moot, because they apply only to those essential services. The health law’s ban on annual and lifetime coverage limits also applies only to essential benefits, meaning they too would be eliminated unless the language of the Republican plan stipulated otherwise.

“It’s an issue of trying to craft a bill that can keep everyone on board,” said Rep. Morgan Griffith, R-Va., a member of the Freedom Caucus who supported the initial legislation. “Some of my friends on the right need to figure out that we can’t get everything we want. Some of my friends in the center need to figure out that they can’t get everything they want.

“We all agreed on repeal. It’s the replacement that causes the problems.”

Lesley Clark: 202-383-6054, @lesleyclark