House Republicans seemed optimistic Wednesday morning coming out of their conference meeting— their first, full-conference gathering since their two-week recess—about the prospect of reviving their Obamacare repeal push with a new agreement between one prominent moderate and a leader of the hard-right faction of the House. Whether the deal actually secures enough votes to make the GOP’s failed health care legislation, the American Health Care Act, passable out of the lower chamber is still very much an open question
The new amendment proposed for the bill appears to have stirred some movement among skeptical conservatives towards favoring the bill. At the same time, some moderates who had been uncomfortable with the original legislation were reticent to say Wednesday whether the new proposal would out them solidly in the “yes” column. Other centrists and rank-and-file members previously supportive of AHCA were hopeful that the new proposal would hit the sweet spot in securing the 216 votes needed to pass the repeal, while leadership kept expectations down.
“It helps us get to consensus,” Speaker Paul Ryan (R-WI) said at a press conference after the morning meeting.
The new proposal was crafted by moderate Tuesday Group co-chair Rep. Tom MacArthur (R-NJ) and House Freedom Caucus Chair Mark Meadows (R-NC) over the recess, with the involvement of Trump administration officials. It allows states to apply for waivers from certain insurer mandates under Obamacare.
So far, conservatives seemed most excited about that changes.
Rep. David Brat (R-VA), a vocal critic of previous iterations of the health care bill, said the proposal made him a yes on the legislation, because it gives states the “ability opt out of regs to lower prices.”
“I think it’s a step in the right direction,” Scott DesJarlais (R-TN), a member of the Freedom Caucus who had wavered on supporting the original bill, told reporters Wednesday.
Additionally some influential conservative groups who had opposed previous versions of the bill issued statements of support of the new changes. The Freedom Caucus will meet Wednesday evening to further discuss the proposal.
Moderates have been less eager to share how the proposal affected their votes.
Rep. Barbara Comstock (R-VA), who came out against the original bill before it was pulled from the floor, told reporters while heading into the meeting that she hadn’t had a chance to look at the new language. Coming out of the conference meeting, Rep. Ryan Costello (R-PA) said that he was not a firm yes or no yet.
“The concerns are what they have always have been, and I’ll have to look at what the amendment does, what the implications may be,” Costello, who was undecided on the original bill, told reporters.
Rep. Charlie Dent (R-PA), who co-chairs the Tuesday Group, said Tuesday he was still opposed to the bill, as did Rep. Leonard Lance (R-NJ).
Nonetheless, Rep. Kevin Cramer (R-ND) told reporters that he believed the new proposal found a “sweet spot” for moderates by bringing back essential health benefits, an ACA mandate that was gutted by the original bill, but giving the states the option to waive them.
“I think it could be a sweet spot that attracts enough people to get us to a majority,” Cramer said.
According to the moderate Rep. Chris Collins (R-NY), a Trump ally who was supportive of the original bill, members at the conference meeting were told that the whip team would start reaching out to previous “no” and “lean no” votes to see if their votes had changed with the amendment. Those who were “yes’s” on the original bill would be assumed to be still be supportive, Collins said, unless they approached leadership to tell them that the new proposal had changed their vote.
“There is no definitive timeline” on bringing it to a floor vote, Collins said, pointing to the need to pass a government funding bill this week.
“Everyone would like to do it sooner than later, many of us would like to do it this week. The Speaker was clear: we will bring it to the floor when we have the votes to pass it,” Collins said.
The new proposal, according to legislative text leaked by Politico, is similar to what was being floated before recess and would allow states to waive out of certain Affordable Care Act insurer mandates.
The first waiver, which would be available to states in 2018, would allow states to extend the so-called age band—which sets the maximum premium ratio between a plan’s youngest and oldest consumer—from its current three-to-one limit. (It’s unclear how this interacts with the previous version of the repeal bill, which already extended the ratio to five-to-one).
The second waiver would let states rewrite and scale back the ACA’s essential health benefits, the 10 coverage areas insurers are now currently required to offer. That waiver would be available in 2020.
The third type of waiver applies to the ACA’s so-called community ratings, which currently restrict insurers underwriting based on health and other factors. Under the proposal, states could permit insurers to engage in some underwriting, specifically based on one’s health’s status, if the state participated in some sort of high risk pool, reinsurance or risk sharing program. The proposal also stipulates that those who maintain continuous coverage would not be subject to that kind of underwriting.
In their waiver applications to the Health and Human Services Department, states would have to describe how their request would help the state one of a few goals, such as lowing average premiums or increasing coverage. If HHS doesn’t respond in 60 days, the waiver would automatically be granted.
“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a health law specialist at Washington an Lee, wrote on Health Affairs blog Tuesday night.