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Alice Ollstein

Alice Ollstein is a reporter at Talking Points Memo, covering national politics. She graduated from Oberlin College in 2010 and has been reporting in DC ever since, covering the Supreme Court, Congress and national elections for TV, radio, print, and online outlets. Her work has aired on Free Speech Radio News, All Things Considered, Channel News Asia, and Telesur, and her writing has been published by The Atlantic, La Opinión, and The Hill Rag. She was elected in 2016 as an at-large board member of the DC Chapter of the Society of Professional Journalists. Alice grew up in Santa Monica, California and began working for local newspapers in her early teens.

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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.

As the White House and GOP leaders scramble to win back several prominent defectors from their bill to repeal the Affordable Care Act, Senate Minority Leader Chuck Schumer (D-NY) took to the Senate floor Wednesday morning to warn wavering House members not to stake their reputations on a bill unlikely to ever to reach the President’s desk.

“Even if the new version of Trumpcare passes the House—we hope it doesn’t—its chances for survival in the Senate are small,” he said. “So to my moderate Republican colleagues in the House, I ask, why would you risk a yes vote for a bill that is devastating to your constituents and has virtually a minuscule chance, probably no chance of becoming law?”

Schumer also criticized both the policy and process behind the American Health Care Act, which he repeatedly branded “Trumpcare,” saying a new amendment drafted Tuesday night will do little to solve the basic problems at the heart of the legislation.

“The significant changes House Republicans are proposing to the bill would still cause premiums and deductibles to rise, would still jack up the costs on low-income and older Americans, and most importantly, it doesn’t change a thing about the 24 million fewer Americans who would get health care,” Schumer said. “Second, it’s unwise, irresponsible to rush through a brand-new bill without a new [Congressional Budget Office] score, without committee hearings, without any debate on the floor of the House.”

Schumer noted that without an analysis from the non-partisan CBO, which calculates the impact of legislation on the federal deficit, it is far from certain that the bill can pass the Senate on a simple majority vote under the reconciliation rules. The CBO reported in March that the original GOP health care bill would reduce the deficit by more than $300 billion dollars over a decade. But lawmakers have made several major changes to the bill since then, and are not seeking an updated score.

President Donald Trump and GOP leaders are asserting that their bill to repeal the Affordable Care Act will protect people with pre-existing conditions—despite fact that the current bill allows states to waive the protections, giving insurers a green light to jack up the rates of those with a chronic illness or disability.

Other rank-and-file lawmakers have been more blunt.

“People can go to the state that they want to live in,” Rep. Robert Pittenger (R-NC) told reporters Tuesday morning when asked if people with pre-existing conditions could be charged much more under the American Health Care Act.

“States have all kinds of different policies and there are disparities among states for many things: driving restrictions, alcohol, whatever,” he continued. “We’re putting choices back in the hands of the states. That’s what Jeffersonian democracy provides for.”

Pittenger acknowledged that under an amendment to the bill rolled out in April to win over the support of hardline conservatives, states can apply for waivers to Obamacare’s community rating rule, which limits how much insurance companies can charge people with pre-existing conditions. With no limit set in the bill for what insurers could charge, many patient advocacy groups say they’re afraid millions of people could be priced out of health insurance entirely.

Under the GOP’s amended bill, states could also seek waivers to Obamacare’s essential health benefits rule, allowing insurers to sell bare bones plans that don’t cover things like prescription medicine, emergency room visits, or maternity care.

“This is federalism,” Pittenger said. “This brings the choices back to the American people and back to the states.”

Tierney Sneed contributed reporting.

As House Republicans struggle to secure the 216 votes needed to pass their bill to repeal the Affordable Care Act, GOP leaders are making both vague and concrete offers to the remaining holdouts in their conference.

Rep. Lou Barletta (R-PA), who previously opposed the American Health Care Act out of fear undocumented immigrants could somehow receive tax credits to purchase health care, said that his vote has been won over by promises from President Trump and GOP leaders that they will advance a separate bill this month that “will require that a person’s Social Security number is verified before we give them a tax credit.”

“I talked to the President at length last night and he agreed 100 percent that he wants it fixed as well,” Barletta told reporters Tuesday. “So my issue is going to be taken care of. I’ve got a letter that puts in writing, from Treasury and Homeland Security.”

Barletta asserted that these assurances will win over more undecided votes than just his, but wouldn’t cite a number of lawmakers or provide any names.

Rep. Kevin Brady (R-TX), chair of the influential Ways and Means Committee, confirmed the promised vote on Barletta’s bill, and said it was just one of several they would move forward in order to win over remaining outliers. “We have several improvements to the [Obamacare] replacement that will go separately,” he told reporters. “I intend to include Mr. Barletta’s bill. It’s really an excellent piece of legislation. We haven’t set a date for a markup yet but I anticipate it coming before the end of the month.”

Leaders also secured the vote of Rep. Paul Gosar (R-AZ), until recently a staunch critic of the bill, by promising a vote on his pet issue.

Yet even as leaders float the possibility of a vote this week, lawmakers seemed unsure of whether changes are still being made to the text of the bill itself.

“It’s not final yet,” said Rep. Peter King (R-NY), who has not committed to supporting the AHCA but is leaning in that direction. “We certainly haven’t seen the final language. We’re still talking about possible changes. Nothing specific, just people saying we should do this or that.”

“If they don’t have the votes, they have to make changes,” King said. “They want to get it done.”

One of those changes, Brady confirmed, will strip out the exemption for members of Congress that was tucked into the bill last week.

Yet other members who remain on the fence about this bill say they are not getting similar offers of policy tweaks.

Rep. Carlos Curbelo (R-FL), who is undecided and leaning towards a no vote, said his call for “expanded tax credits for low-income people and those approaching the age of retirement” has not been heeded by leadership.

“The changes I’m asking for probably won’t be made here,” he said.

Asked how leadership is trying to win his vote, Curbelo said ruefully: “They’re not trying to convince me.”

 

Despite immense pressure this week from GOP leadership and the White House—which desperately wanted their Obamacare repeal bill to pass within President Trump’s first 100 days in office—moderate Republicans held out. Trumpcare 3.0 met the same fate as its previous iterations, and everyone promised to try again later.

Rep. Charlie Dent (R-PA), the co-chair of the centrist Tuesday Group, says he and his colleagues have so many concerns about the core policies in the plan that Republicans should consider starting over. “We need to change the paradigm,” he told reporters Friday. “I think the bill has got too many problems, and they need to rework it from the center out.” Specifically, Dent and other holdouts cite the bill’s deep cuts to Medicaid, rate hikes for older Americans, and insufficient protections for people with pre-existing conditions.

But GOP leaders are not heeding his advice, and are instead vowing to keep trying to get the same Obamacare repeal bill to President Trump’s desk in the weeks to come. These are the not-yet-addressed concerns that will come back to haunt them.

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President Trump will unveil Wednesday a proposal to slash the corporate tax rate from 35 to 15 percent—a change that would balloon the federal deficit by an estimated $2 trillion dollars over a decade. The plan will reportedly include additional cuts to the income tax rate paid by high earners and a tax credit for child care that would mostly benefit the wealthy, at further cost to the federal budget.

While some Republican lawmakers cheerfully echoed to TPM the White House line that the tax cuts will “pay for themselves” by spurring massive economic growth, both official government analyses and conservative economists are much more skeptical.

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After a two-weeks of being berated by their constituents at raucous town halls—and watching Democrats come close to flipping two solidly red districts in Kansas and Georgia—members of Congress return to DC Monday. With few legislative accomplishments under their belts so far, they now face a government funding deadline, a debt ceiling increase, demands from the White House to take another swing at repealing Obamacare, and the daunting, likely impossible task of overhauling the tax code by August.

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