As Thursday’s House vote on the bill to repeal the Affordable Care Act looms, the pressure is ramping up on GOP lawmakers who remain undecided or opposed to the legislation. Even after threats to their careers, invitations to the White House, special carve-outs for their states, amendments on their pet issues, and other tactics, critics of the bill still say enough members are holding strong to ensure the bill will fail on the House floor.
As the clock ticked down on Wednesday, Republican leaders made a new promise to the dissenters: that the Senate will add a provision gutting Obamacare’s Essential Health Benefits (EHB) rule once the House passes the bill and sends it their way.
The EHB rule, which the current House GOP repeal bill retains, requires that insurance plans have to cover a basic minimum of health care services, including emergency room visits, hospitalization, outpatient services, maternity care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services, lab tests, preventive care like vaccines, and vision and dental care for children.
Rep. Richard Hudson (R-NC), the deputy whip in the House, told TPM he received assurances Wednesday from Senate Majority Leader Mitch McConnell (R-KY) that he would amend the bill when it comes to the Senate to include a provision stripping out EHBs. McConnell’s office did not respond to TPM’s attempt to confirm Hudson’s account.
Hudson said he was further promised that the White House would back the move. “The president personally guaranteed that he would publicly call for it,” he said. Politico later reported that White House budget director Mick Mulvaney is working with the House Freedom Caucus on the details.
This new promise was already winning over many previously dissenting conservatives, said Hudson, who is part of the team charged with securing the votes for passage—enough that he’s confident the bill will pass the House Thursday night.
“I think it’s starting to sink in for people that we really are going to have a vote tomorrow,” he went on. “Before, people were operating under two different theories: that we could add anything we want to this and the Vice President would overrule the [Parliamentarian], and that if folks hold out long enough, the Speaker would blink and pull the bill. They’re realizing he’s not going to pull the bill, and Pence let the Freedom Caucus know today that he’s not going to overrule. That unicorn is not going to fly.”
“Do unicorns fly?” wondered Hudson.
Asked if the EHB provision could pass the Senate’s reconciliation rules, which allow certain budget bills to pass with a simple majority and avoid a filibuster, Hudson was unsure.
“It’s a gamble,” he admitted. “The [Senate Parliamentarian] says it can’t [be included]. That’s pretty definitive to me, but there are other conservatives out there who think it can be. So it’s a safer gamble to let McConnell do it so we don’t lose our entire bill if we’re wrong.”
Bill critic Sen. Mike Lee (R-UT) is one of those “other conservatives.” He said Wednesday that the Senate Parliamentarian told him it “may be possible” to repeal EHBs through reconciliation.
“What I understood her to be saying is that there’s no reason why an Obamacare repeal bill necessarily could not have provisions repealing the health insurance regulations,” he told the Washington Examiner.
Sen. Mike Lee (R-UT)
Democrats in the Senate disagree. Matt House, the spokesperson for Senate Minority Leader Chuck Schumer (D-NY) wrote on Twitter that trying to pass a repeal of EHBs through the reconciliation process “violates the Senate rules and won’t happen.”
“This is merely a plot to get the bill out of the House,” he said. “Provision won’t ultimately survive in the Senate.”
As the health care debate has roiled Capitol Hill over the past couple weeks, some conservatives have been demanding the elimination of the EHB rule, arguing that insurers should be once again be allowed to offer dirt-cheap, bare-bones plans to consumers who prefer them.
Allowing this change, however, would cost the federal government dearly.
Expert analysts say more people would use their federal tax credits to purchase these skimpy plans rather than going entirely uninsured, meaning the legislation would not achieve anywhere near the $337 billion in deficit reduction originally predicted. The health care consulting firm Milliman also argues that gutting the benefits would also do far less to lower insurance premiums than supporters of the move claim.
As of Wednesday afternoon, the bill’s passage was still not a given, as other lawmakers told TPM they have other problems with the current bill that are not addressed by the EHB offer.
“I’ve got some serious concerns still,” Rep. Mario Diaz Balart (R-FL) said. “I think the 50- to 65-year-old population will have a more difficult time getting insurance and it will be more expensive. They are not being dealt with in a way that’s giving me a lot of comfort.”
Rep. Charlie Dent (R-PA), a member of the moderate Republican Tuesday Group, told reporters he and several other members remain critical and uncommitted. “The tax credits are still a problem. There’s not enough flexibility with Medicaid,” he said. “The Planned Parenthood issue ought to be separated out of the bill. Those are my principal objections.”
This post has been updated.