Tierney Sneed contributed reporting.
Even as rumors of a House vote as early as Thursday to repeal the Affordable Care Act rippled around the Capitol Wednesday afternoon, lawmakers told TPM they have not yet seen the final text of the bill, will not wait for the Congressional Budget Office to analyze it, and do not know if there are enough Republican supporters to ensure its passage.
It’s become a near-weekly ritual for the White House to demand a vote on the ever-evolving American Health Care Act only to see momentum fizzle out and negotiations move behind closed doors. But this time, Republican lawmakers swear they are within just a few votes of sealing the deal.
“I’m told that all systems are go,” Rep. Mark Sanford (R-SC) told reporters. “My suspicion is that the vote will come tomorrow.”
Some lawmakers wondered aloud if the vote would happen Thursday or Friday, while others floated the possibility it could move late Wednesday night.
“I don’t know. I wish I knew. I wish I had news for you,” said Rep. Brett Guthrie (R-KY).
Many lawmakers reported that President Donald Trump has been pushing hard for a vote as soon as possible, phoning individual members, summoning dissenters to the White House, and winning over holdouts with personal pleas.
Rep. Bill Flores (R-TX) told reporters Wednesday that when it came to health care negotiations, Trump has “been all over this like a dog on a bone.”
Yet negotiating with a president who has no political experience and little knowledge of health care policy hasn’t been easy.
“This president has more philosophic dexterity than most presidents I’ve dealt with in the past,” Sanford said with a smile on Wednesday. “That makes it a little different. Typically there’s a fixed starting point and a fixed ending point.”
Thanks to that “dexterity,” Sanford and the rest of the Freedom Caucus extracted major concessions from Trump and Republican leadership over the past few weeks, including provisions that will allow states to waive Obamacare’s rules that ensure essential benefits are covered by all health care policies and that protect people with pre-existing conditions from being priced out of the market.
That left moderate Republicans, who fear those amendments will severely hurt their constituents, in the hot seat.
House GOP Leadership unveiled a new amendment late Tuesday night to try to win back their support—a provision that would allocate an additional $8 billion dollars over five years for states that waive cost protections for people with pre-existing conditions.
“You know, based on the past it seemed like an appropriate amount,” Rep. Greg Walden (R-OR), chair of the Energy and Commerce Committee, explained. “It’s like, what do we think the right amount will be? This seemed to be the logical amount.”
Walden added that the money won’t need to be spread over several states, because: “If you go way back, there weren’t that many states that created their own high risk pools anyway,” he argued. In fact, prior to the Affordable Care Act, 35 states did so.
Even the author of the amendment, Rep. Fred Upton (R-MI), seemed to struggle when pressed on how exactly the policy would work.
“What it in essence does is it takes $8 billion dollars—in essence, new money, for 5 years,” he said, “and it’s provided to the risk pools to those states that have sought successfully a waiver to deal with their future.” Upton added that this money would help “buy down” the premiums of people in those high-risk pools.
But when asked if amendment could actually incentivize states to waive protections for people with pre-existing conditions, since those who maintain them can’t receive the money, several lawmakers appeared unsure.
“That’s a good question,” Rep. Carlos Curbelo (R-FL) responded. “The amendment hasn’t been filed yet. I want to see it once it gets filed.”
“I haven’t seen the language, so I don’t know that it really does that,” Rep. Bill Flores (R-TX) told TPM. “I’ve only heard about what’s in it.”
Flores added that he wasn’t troubled that the House was barreling towards a vote without waiting for an analysis from the Congressional Budget Office on how it would impact the federal deficit and how many people could lose their health insurance if it passes.
“I can take the numbers we had before and add from there,” he said.
The Congressional Budget Office reported in March that the original GOP health care bill would reduce the deficit by more than $300 billion over a decade. Lawmakers have made several major changes to the bill since then—allocating tens of billions of dollars for high-risk pools and allowing states to sell insurance that doesn’t cover essential health benefits—but are not seeking an updated score.
Lawmakers shrugged off concerns that the additional funding for high-risk pools in the new amendment would expire after just five years.
“I think you’ll see that pre-existing condition premiums, for the most part, come down, not up,”Rep. Mark Meadows (R-NC) told TPM. “If you look at the Maine model, they actually came down.”
Maine’s high-risk pool system—however—was much more subsidized than what Republicans are proposing, and premiums still sharply increased for many older patients and small business employees.
“I think what you’ll see a real effort to make sure people with pre-existing conditions are taken care of,” Meadows asserted.