Policy

Republicans Have No Deal on Obamacare Repeal But Talks Continue

Trump: “We are doing very well on health care.”

Rep. Mark Meadows, R-N.C., arrives for a hastily called House Republican caucus meeting after Speaker Ryan canceled the vote on the American Health Care Act of 2017 on Friday, March 24, 2017. (Bill Clark/CQ Roll Call)

House lawmakers are preparing to return to Capitol Hill next week with no deal so far on legislation to repeal the 2010 health care law, but negotiations are continuing as Republicans seek to fulfill their seven-year campaign promise, according to several congressional aides and lobbyists. Lawmakers are expected to discuss the issue in a conference call Saturday.

The White House is pushing for work to continue on efforts to repeal President Barack Obama’s signature health care achievement. House Freedom Caucus Chairman Mark Meadows, R-N.C., and Rep. Tom MacArthur, R-N.J., co-chairman of the moderate Tuesday Group, discussed over the recess a potential amendment that was designed to build support from hesitant lawmakers on both sides of the GOP political spectrum.

President Donald Trump, at a press conference on Thursday with the Italian Prime Minister, remained optimistic that Congress would advance legislation to repeal the health law despite the setbacks the House has endured. He cited the difficulty Democrats faced when trying to pass Obamacare.

“We are doing very well on health care,” Trump said during a press conference Thursday with the Italian prime minister. “I’d like to say next week, but I believe we will get it . . . whether it’s next week or shortly thereafter.”

However, congressional aides were quick to say there are no signs that the House would be ready to vote on a proposal next week, despite other media reports suggesting the chamber would vote on Wednesday.

“The question is whether it can get 216 votes in the House and the answer isn’t clear at this time. There is no legislative text and therefore no agreement to do a whip count on,” a senior GOP leadership aide said.

“We are still in the same place we’ve been with no timetable or set date” for a vote, a White House aide said.

MacArthur sought to draw attention Thursday to the discussions.

“Throughout this negotiation process Congressman MacArthur has been fighting to protect the most vulnerable Americans. He has insisted during these discussions that any legislation must have protections for pre-existing conditions,” his office wrote on a social media post Thursday. “This amendment will make coverage of pre-existing conditions sacrosanct for all Americans and ensures essential health benefits remains the federal standard.”

Critics noted that the amendment would allow states to opt out of several Obamacare consumer protection guarantees, such as a provision in the law banning insurers from charging certain consumers higher rates.

Democrats pushed back on the proposal.

“Republicans’ latest plan is to expose Americans with pre-existing conditions to staggering new health costs,” House Minority Speaker Nancy Pelosi, D-Calif., said in a statement. “Now, by gutting protections for people with pre-existing conditions, Republicans will make it all but impossible for millions of Americans fighting illness to afford the health coverage they desperately need.”

During a members-only conference call earlier this week hosted by the House Energy and Commerce Committee, no updates on efforts to repeal the health law were provided, aides said. On the conference call scheduled for all House Republicans on Saturday, members are likely to discuss a number of issues including health care, aides said. Funding the government beyond April 28 is expected to be the highest congressional priority next week. 

Recess activity

Republican lawmakers spent the last two weeks hearing from constituents back in their home districts. Moderate and conservative Republicans alike hosted town halls, some more confrontational than others, and heard from individuals both in favor of and opposed to current efforts to repeal the health care overhaul. Some aides expect members to return to Washington with a renewed sense of energy toward finding a legislative solution that has evaded House Republicans since leadership abandoned a scheduled vote on a repeal bill last month.

House Speaker Paul D. Ryan of Wisconsin, speaking to a policy think tank in the United Kingdom on Wednesday, said discussions were ongoing.

“We’re in the midst of negotiating sort of finishing touches because our members want to make sure we lower premiums, that a person that is buying health insurance has a lot of choices,” he said. “It’s just going to take us a little time to do that.”

What remains to be seen is how the break from regular congressional activity might have changed the attitudes of some members. 

The amendment that Meadows and MacArthur were working on would generally maintain large portions of the health care law — like the ban on insurers denying coverage to individuals with pre-existing conditions — but would allow states to apply for a waiver to opt out of some requirements, according to a one-page summary obtained by CQ Roll Call.

Under the proposal, states would need to prove that the waiver would either reduce insurance costs, increase the amount of individuals who have health coverage or “advance another benefit to the public interest.” The addition of such an amendment, however, could drive away moderate lawmakers.

In the meantime, outside groups are stepping up their pressure on Republicans. The conservative Club for Growth launched a second round of attack ads last week on GOP members who it says are opposed to proposed changes to the repeal measure.

Debate over subsidies

Apart from work on repealing the health care overhaul, Republican lawmakers also continue to face substantial pressure from the insurance industry to fund the law’s cost-sharing subsidies that provide funding to lower-income individuals to help with payments for out-of-pocket costs such as copays and deductibles.

The House is currently embattled in a lawsuit with the Trump administration over the payments. Ryan has said the administration should continue to pay out the subsidies while the lawsuit is ongoing, but President Donald Trump has not committed to providing them and alluded to using the payments as a tool to bring Democrats to the negotiating table.

The National Association of Insurance Commissioners sent a letter on Wednesday to Democratic and Republican House leaders urging them to fully fund the fiscal 2017 cost-sharing subsidy payments.

“Your action is critical to the viability and stability of the individual health insurance markets in a significant number of states across the country,” the group wrote. “Funding the cost-sharing reduction payments will go a long way toward stabilizing the individual markets in our states while legislative replacement and reform options are debated in Congress.”

Lindsey McPherson contributed to this report. 

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