Second time not a charm...

Republicans finalize new (Affordable Care Act) Obamacare repeal proposal

The plan is expected to win more support from the conservative Freedom Caucus, but it’s still unclear whether the bill can pass the House.

By RACHAEL BADE , JENNIFER HABERKORN and JOSH DAWSEY

The White House, top House conservatives and a key moderate Republican have finalized a new Obamacare repeal and replace plan they hope will break a month-long logjam on a key priority for President Donald Trump.

But it is far from clear that the fragile agreement will provide Speaker Paul Ryan the 216 votes needed for the House to pass the stalled legislation.
Optimism is growing among Republican officials on the Hill and in the White House. Leadership will likely need at least 15 to 20 new House Freedom Caucus votes to have any shot at passing the bill.

The million-dollar question: Can Freedom Caucus Chairman Mark Meadows, who helped author the changes, deliver the votes needed to get the bill over the finish line? The North Carolina Republican is said to support the amendment, sources say, but it's still unclear how many of his group will flip from "no" to "yes."

There are positive signs, even though the Freedom Caucus appears to have made a conscious decision to say little until discussing the matter at a Wednesday evening meeting.

Reps. Dave Brat (R-Va.) and Scott DesJarlais (R-Tenn.), both of whom opposed prior versions, indicated they will back the legislation once the new provisions are added to allow states to opt out of some Affordable Care Act consumer protections. While DesJarlais is a huge Trump supporter and was visibly torn about opposing the bill last time around, Brat's change of tone is more notable given his reputation as a care-free leadership antagonist who has zero problem opposing GOP leadership or Trump.

The changes come after more than two weeks of behind-the-scene work between Vice President Mike Pence, Meadows and Tuesday Group co-chairman Tom MacArthur (R-N.J.), a moderate who was already supportive of the bill.

Most of the Freedom Caucus opposed the Obamacare repeal bill that Ryan pulled from the House floor last month because it did not repeal Obamacare regulations, calling the proposal “Obamacare lite.” Afterward, Trump and numerous House Republicans blamed the group for stalling a major GOP priority; Trump even threatened to primary some of the group members and turned his Twitter followers on their leaders.

Privately, however, the White House started courting them and the deep-pocketed outside groups that also opposed the legislation and are close with the Freedom Caucus. Those organizations, including Heritage Action, Club for Growth and several run by the Koch brothers, signaled to the White House they wanted a deal.

The new agreement gives the Freedom Caucus some additional concessions, including waivers that allow states to opt out of major Obamacare regulations touching on essential health benefits and when insurance companies can charge higher premiums.

It is unclear if the entire Freedom Caucus will take an official position, which would require support from 80 percent of its members. Some Freedom Caucus members, including Reps. Mo Brooks (R-Ala.) and Justin Amash (R-Mich.) told reporters they’re considering the changes. Freedom Caucus Vice Chairman Jim Jordan (R-Ohio) declined to tell reporters Tuesday evening whether he supports the bill, running away from reporters and shouting over his shoulder: "We’ve got a meeting tomorrow!"

Brat is likely to support the bill if the legislative language matches the policy that’s been discussed. “The Pence compromise [is] very promising, a lot of people like it,” he said.

Should 20 additional Freedom Caucus members sign onto the agreement, GOP leaders — who have stayed back in the latest negotiations — will then turn to moderates to try to lock in the needed votes.

While MacArthur helped negotiate the plan, many centrist Republicans are wary of the agreement and not happy that the White House pushed the plan further right. They are concerned that it will leave people with pre-existing conditions out to dry, as states could opt out of a regulation baring insurance companies from charging sick people higher premiums.

Supporters of the plan, which is also expected to include House GOP leadership, argue that the deal requires any states that opt-out of such regulations to create risk pools that will pay much of the higher premiums sicker people may face. Some worry, however, they won’t be funded enough to cover everyone who needs help.

The centrist Tuesday Group is scheduled to meet Wednesday to discuss the changes, though already several prominent group members, including co-chair Charlie Dent (R-Pa.), have panned the changes.

Officials at the White House and on Capitol Hill are unsure how many moderates, many of whom have already declared themselves as "no,” will back the legislation, but they have begun making calls. So far, no moderate “no” votes have publicly changed their position to “yes."

White House officials are striking an optimistic tone about the legislation, even suggesting the House could vote on the measure as soon as this week — perhaps crossing their fingers for a last-minute victory to mark Trump's 100-day in office on Saturday. House GOP leaders have downplayed the possibility.

The GOP’s new proposal would allow states to opt out of many of Obamacare’s requirements, allowing health plans to charge people more based on their age and health status. States could also opt out of enforcing a 30 percent surcharge imposed on people who don’t maintain insurance coverage, which was part of the original GOP proposal, according to a brief update sent to Energy and Commerce members. That’s the policy that the Republicans would use to replace the Obamacare individual mandate.

In exchange, states would have to set up a high-risk pool where older, sicker people could buy coverage, likely at much higher prices.

The waivers would strongly encourage people to maintain continuous coverage — even more than prior versions of the Republican repeal bill. In states that get a waiver, people who don’t stay insured could be charged more for insurance policies based on their health status.

In order to obtain the waiver, states would have to show that they would reduce premiums, increase health insurance enrollment in the state, stabilize the market for health insurance coverage, stabilize premiums for individuals with pre-existing conditions or increase the choice of plans in the state.

The amendment also includes what it calls “default approval” for waivers — a key ask from some conservatives. That means states’ waiver applications would automatically be approved, and the onus would be on the Health and Human Services secretary to reject their applications in 60 days if the administration doesn’t believe the state has fulfilled its obligations.

Moderate Republicans were hoping the hurdle to secure a waiver would be high.

The changes includes language specifically barring insurance companies from discriminating against people with pre-existing conditions. “Nothing in this act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions,” it reads.

But centrists worry that will effectively happen if insurance companies can charge sicker individuals more.