Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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House Republicans were in a celebratory mood Thursday after narrowly passing their Obamacare repeal bill. Now they get to watch the Senate do something completely different.

After weeks of holding at arm’s length the messy negotiations in the lower chamber, Senate Republicans on Thursday made clear that they had started working on their own bill, albeit one that will “incorporate” some parts of the House bill, according to Sen. Roy Blunt (R-MO), a member of GOP Senate leadership.

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Alice Ollstein contributed reporting.

After a dizzying few days of horse-trading and last-minute changes, House Republicans passed their Obamacare repeal bill Thursday, checking off a years-long promise and unexpectedly overcoming an embarrassing false start earlier this year.

The legislation would impose massive cuts to Medicaid, rework the Affordable Care Act, make many of the ACA’s consumer protections optional for state and eliminated many of the law’s taxes, which Republicans say will shore up savings for their tax cut plan.

The vote was 217-213.

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While House Republicans defend the swiftness with which they’re bringing an Obamacare repeal bill to a vote after a number of last-minute changes, one of their GOP counterparts on the other side of the Capitol said he was “concerned” about their process.

About an hour before the American Health Care Act was scheduled for a vote, Sen. Lindsey Graham (R-SC) tweeted that the legislation “should be viewed with caution.”

House Republicans are expected to pass their bill Thursday without seeing an updated Congressional Budget Office score on some major changes they made in the last two weeks to shore up support for the legislation. Among those changes is a waiver option for states to opt out of certain Affordable Care Act insurer mandates.



This post has been updated.

Beyond reshaping the individual health insurance market, the version of the Obamacare repeal plan that House Republicans intend to vote on Thursday could have major implications on employer plans and may even make consumers in the large group market vulnerable to a weakening of the current law’s consumer protections, health care experts have suggested.

The argument is an open question, according to health law specialists, and likely hinges on how the Trump administration interprets previous Obama-era guidance for the Affordable Care Act.

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If House Republicans ultimately pass their beleaguered Obamacare repeal bill this week, they’ll have Rep. Fred Upton (R-MI) to thank for an amendment he has pushed that is set to be unveiled Wednesday.

In a 10-minute conversation with reporters Wednesday afternoon, Upton was a little wobbly on the specifics of the amendment and exactly when he decided that it would be enough to change his mind on the legislation.

Only a day ago, Upton, a former chair of the Energy and Commerce Committee, came out publicly as a “no” on the American Health Care Act as it then stood, citing its weakening of protections for those with pre-existing conditions. His opposition at the time was considered to be a potential canary in the coal mine for a larger revolt against the bill. Moderates had been spooked after the legislation was amended last week to allow states to opt out of certain Affordable Care insurer mandates, including requirements that banned insurers for upping premiums based on one’s health status.

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A prominent Republican who defected from the GOP’s Obamacare repeal legislation Tuesday is working on an amendment to win over himself and possibly other skeptical moderates, the Associated Press, Axios and the New York Times reported.

The idea is being floated by Rep. Fred Upton (R-MI), a former Energy and Commerce chair who has worked on the health care legislation in the past and came out against the latest iteration of the repeal bill due to its weakening of pre-existing-condition protections. He is seeking an additional $8 billion over five years for the bill’s “Patient and State Stability Fund,” which offers states funding to set up high-risk pools or other market stabilization programs.

According to the Axios report, the funding would specifically be for consumers with pre-existing conditions who see their insurance premiums jacked up for not maintaining continuous coverage, as could be possible under the Republican plan.

It’s unclear whether the funding would undermine the point of the penalty to encourage consumers into maintaining insurance, or whether it would incentivize insurers to charge the penalty in order to sop up the public funding.

Other outlets described the measure more broadly as funding to boost high-risk pools, which Republicans say will act as a safety net for consumers who potentially couldn’t afford coverage due to pre-existing conditions.

Upton’s office has not yet responded to TPM’s request for clarification. His aides told CQ he was slated to visit the White House this morning with other Republican lawmakers key to the House’s repeal effort.

The proposal is the latest of a series of ad hoc changes that the legislation, the American Health Care Act, has undergone in order to shore up the 216 votes it would need to pass the House. The bill was pulled dramatically from the floor in March, with GOP leadership facing a revolt from its hard-right as well as centrist factions. Last week, an amendment was unveiled allowing states to opt out of certain Affordable Care Act insurer mandates, including its requirement that plans offer coverage in 10 broad coverage areas and its ban on upping premiums based on an individual’s health states.

That change won over many of the conservative resisting the bill, but spooked the moderates, who worried it violated their vows to preserve protections for pre-existing conditions. GOP leaders have pointed to the high-risk pools states could set up using the bill’s stability fund as an answer to that concern. Most health care experts estimate that the cost of a high-risk pool to cover those with pre-existing conditions far exceeds what Republicans were offering in the legislation: $100 billion over 10 years. An extra $8 billion over five years is still short of the $20-$30 billion a year that has been the conservative estimate of what such a program would cost.

Alice Ollstein contributed reporting.

For the last few months, House GOP moderates who have been uncomfortable with their party’s Obamacare repeal bill have had the raucous complaints of House conservative hardliners about the legislation to hide behind. But that shield has fallen, the hardliners are supporting the bill, and now it’s the votes of Republicans from purple and blue districts that determine the fate of the legislation. Those moderates are squirming under the new spotlight chasing them around the Capitol as reporters feverishly construct their own whip counts.

Around 20 moderates have come out against the bill, and handfuls more have retreated into the undecided column. But unlike their House Freedom Caucus counterparts — who relished telling anyone who would listen their demands on Obamacare repeal — the GOP centrists are playing coy about where they stand on the bill and what it would take to move their vote.

”I don’t want to give a full press conference. I answered your question,” Rep. Kevin Yoder (R-KS) told TPM Monday evening after confirming tersely that he was undecided.

Rep. Darrell Issa (R-CA), whose district voted for Hillary Clinton in 2016, smiled like a Cheshire Cat as reporters grilled him Monday evening on where he stands on the bill.

“I have commented many, many times about my undecided position,” he finally said.

Rep. Michael Turner (R-OH) would only say that he was “busy” when a reporter asked him repeatedly Monday evening about his current stance.

Last week a change to the legislation, the American Health Care Act, was unveiled, allowing states to opt out of certain Affordable Care Act insurer mandates. The amendment — hammered out by conservative hardliner leader Rep. Mark Meadows (R-NC) and prominent moderate Rep. Tom MacArthur (R-NJ) — quickly brought most of the House Freedom Caucus on board. For moderates, whose opposition to the original bill was more under the radar, supporting the proposal would put them in violation of a key promise many Republicans made in the repeal fight: that they would preserve Obamacare’s protections for Americans with pre-existing conditions.

Under the new changes, consumers living in states that opted out of the ACA mandate known as community ratings for health status could face higher premiums for any pre-existing conditions.

“We’re going to allow the states to go out there and make a determination for themselves what they want to do in terms of waiving programs. What does that literally mean for people with preexisting conditions? That’s what I need to figure out for myself,” Rep. Brian Mast (R-FL) told reporters coming out of Tuesday morning’s conference meeting. He is now undecided on the a bill, after previously giving a stirring speech encouraging members to vote for it the night before it was pulled from the floor in March.

Top Republicans have said that they are closer than ever on passing the health care bill out of the House. But to get over the finish line, they have had to engage in a new round of arm-twisting. Vice President Mike Pence was at the Capitol Monday afternoon, meeting with members wavering on the bill, such as Yoder and Rep. Mario Diaz-Balart (R-FL).

Diaz-Balart played it cool coming out of the meeting. Asked if he was still undecided, he said he was focusing on the appropriations bill Congress will pass this week to fund the government, and wouldn’t elaborate on what Pence said to him about health care.

The position moderates are in is a tough one: oppose the bill and be blamed for getting in the way of a years-long promise of the GOP; or support it and put yourself at political risk regardless of whether the Senate passes it.

Even before the latest changes, moderates were already feeling the pressure due to the bill’s massive cuts to Medicaid and phase out of the Medicaid expansion. The way the bill restructures the ACA’s tax credits for individual insurance—making them more generous to young people at the expense of older consumers—also puts some members in a pinch.

The current dynamics have allowed some members to assert that more changes are negotiable on the bill, despite the signal from leadership that this is the version they want to move forward.

Rep. Peter King (R-NY) stressed Tuesday morning that he “tend[s] to vote yes” but the current language probably wasn’t final.

“If they don’t have the votes, then they’ll have to make changes,” King said.

As the White House signals a renewed push to bring the GOP’s Obamacare repeal bill to the House floor, a coalition of patient groups reiterated their concerns with the legislation, the American Health Care Act, and came out against the latest round of changes made to the bill that let states waive out of certain Affordable Care Act insurer mandates.

“We are alarmed by recent harmful changes to the AHCA, including provisions that will weaken key consumer protections. These changes include allowing states to waive the requirement for essential health benefits, which could deny patients the care and treatment they need to treat their conditions,” the groups, which represent patients with chronic diseases and other health issues, said in a statement Monday. “Another change allows states to waive protections against health status rating. Weakening these rules would enable insurers to charge higher prices to people with pre-existing conditions, possibly making insurance unaffordable for those who need it most.”

The patient groups signing on to the statement were the American Cancer Society, the Cancer Action Network, the American Diabetes Association, the American Heart Association, the American Lung Association, the Cystic Fibrosis Foundation, JDRF, March of Dimes, the National Organization for Rare Disorders, the National MS Society and WomenHeart: The National Coalition for Women with Heart Disease.

An amendment to the bill to let states apply for waivers from certain ACA insurer mandates was unveiled last week as a compromise between Rep. Mark Meadows (R-NC), the leader of the hard-right House Freedom Caucus, and a prominent moderate, Rep. Tom MacArthur (R-NJ), who co-chairs the centrist Tuesday Group.

The changes did appear to shore up the support of the conservatives. However, some of the moderates who were initially in favor of the legislation appeared nervous about the changes and whether they would violate previous promises by Republicans to protect consumers with pre-existing conditions.

In the statement Monday, the patient groups said that they opposed this latest version of the bill and that they “urge Members of Congress to reject this legislation.”

President Trump’s 100-day mark may have come and gone, but the White House is still engaged in a public, full-court press to get a vote on the Republican Obamacare repeal bill before Congress goes on another recess this week.

The director of Trump’s National Economic Council, Gary Cohn, and White House chief of staff Reince Priebus expressed optimism Monday on CBS’s “This Morning” that they could get the 216 House votes to pass the bill, the American Health Care Act, after Republicans moderates were initially skeptical of the latest round of changes to the legislation.

“Do we have the votes for health care? I think we do,” Cohn said Monday, adding, “We’re convinced we’ve got the votes and we’re going to keep moving on with our agenda.”

Priebus dialed back the confidence level a little bit in a separate interview with This Morning when he was asked about the possibility of a vote.

“I certainly hope so,” Priebus said. “I think it will happen this week.”

According to a report by Politico published Sunday evening, White House officials have been clamoring for a vote this week, suggesting that Congress should be kept in town through the weekend if need be to bring it to the floor.

“This is it,” an administration official told Politico. “We get it done now, or we don’t get it done ever.”

This is not the first time the White House has issued a now-or-never ultimatum on the bill.

House GOP leaders and top congressional aides have been consistent in vowing that they will not bring the bill up for a vote until they know they have the 216 votes to pass it. Speaker Paul Ryan’s office said it had “No schedule updates at this time” when TPM reached out about Cohn’s and Priebus’ comments.

The repeal bill gained some momentum last week when it got the support of the hardline conservative group, the House Freedom Caucus, which had resisted it previously. The problem for GOP leaders is that the changes to the bill that brought the conservatives on board—particularly an amendment that would allow states to opt out of certain Affordable Care Act insurer mandates, including some that protect consumers with pre-existing conditions—have made the conference’s centrists nervous.  Some previous supporters of the bill changed their stance to undecided after the provision was unveiled.

Congress left town on Friday with members saying they were close to having enough votes to pass the bill, but not there yet.