It’s deja vu all over again on Capitol Hill.
Less than two weeks after declaring their bill to repeal the Affordable Care Act “over” and vowing to move on to tax reform and other issues, Republicans are back at it, repeating the exact steps that led to the bill’s demise the first time around.
Once again, we’re seeing extensive concessions to the hardline House Freedom Caucus that the group’s members say still don’t go far enough. Once again, these same concessions are scaring off moderate Republicans. Once again, senators are skeptical that what the House is proposing can pass the upper chamber.
And as with the first bill, President Trump’ White House is once again pushing for a rapid vote—potentially as soon as this week—though no text of the new bill has been drafted, there has been no Congressional Budget Office analysis, and Republicans received few details at Tuesday morning’s conference.
“It was the shortest meeting we’ve ever had,” Rep. Chris Collins (R-NY) told reporters. “The Speaker basically said, ‘We’re talking.’ No timelines were set.”
“The administration would like something this week,” Collins went on. “But a lot of members are saying, ‘Let’s deal with it when we come back [from April recess].’ So that’s the debate: Can we get something done in the next 48 hours?”
The “something” Republicans are discussing involves nominally keeping Obamacare’s Essential Health Benefits (EHB) rule in place but allowing states to apply for waivers permitting insurance plans that don’t cover things like maternity care, prescription drugs, mental health, and addiction treatment. They are also considering allowing states to waive Obamacare’s community ratings rule, which prevents insurance companies from hiking patients’ premiums based on geographic location or health status.
Bridging the divide
Emerging from Tuesday’s brief, detail-free meeting, Rep. Barry Loudermilk (R-GA) expressed optimism that this new proposal will thread the needle. “I think what’s being discussed with the Essential Health Benefits brings everyone together: the moderates as well as the conservatives,” he said.
Members of those two camps are more skeptical.
Following the conference meeting, Freedom Caucus member Rep. Louie Gohmert (R-TX) complained the proposal preserves a troubling power dynamic.
“The federal government is the big boss and we may throw some crumbs to the states,” he told reporters. “The states shouldn’t have to ask the federal government for waiver. The federal government should have to ask states for permission.”
Though lawmakers said they were promised by the White House that waivers would “more-than-likely” be granted to any state that applied, Gohmert warned that a future president may be less amenable.
Yet while Freedom Caucus members fretted the reforms did not go far enough, others feared they go too far. Collins, a member of the centrist Tuesday Group, warned that allowing waivers for community ratings “would hurt the vote count” among moderate Republicans.
It certainly would not gain the vote of Rep. Leonard Lance (R-NJ), who opposed the last version of the bill. He told reporters Tuesday that the waiver proposal would make him: “Not a hard no or a soft no or an intermediate no—just a no.”
“I want to make sure that there is no denial of coverage based on a preexisting condition, if not directly then by effect,” he said, referencing concerns that waiving the community ratings rule would allow insurers to charge people with illnesses and disabilities an exorbitant amount, pushing them out of the market altogether.
Despite assurances from all sides that talks are moving in a productive direction and a vote this week remains a possibility, those involved with negotiations the first time around say they are not holding their breath.
“I sat in on a luncheon with the Freedom Caucus and the three leaders and the president a couple weeks ago, and I just don’t see any overlap,” Sen. Bob Corker (R-TN) told reporters Tuesday.
A senior Republican source shared a similarly dim view with The Hill, saying of the waiver proposal: “While we haven’t picked up any votes yet, this concept is already showing signs of losing a ton of them.”
A fine-tuned machine
The text of the revised bill has not yet been revealed to lawmakers or the public.
Republicans said they were told that the Energy and Commerce Committee is working on drafting the legislation, but committee staff did not respond to TPM to confirm or deny this. Others said the drafting process is not being led by GOP leadership or House committees, but by White House officials, who have repeatedly visited Capitol Hill this week to negotiate with members. But asked by TPM about the timing of potential legislative text and whether the White House is involved in writing it, an official said he had no updates to share.
Some had expressed hope that the text would be revealed at a meeting late Tuesday night between White House officials, the Freedom Caucus, and moderate Republicans, but they left empty handed.
The uncertainty is bothering some lawmakers, who are scheduled to return home to their districts this Friday and face their constituents.
“It’s not the best spot to be in,” Rep. Steve Womack (R-AR) told TPM. “We are the governing majority and they kind of expect us to say, ‘This is what we plan to do.’ It will be reasonable and understandable if my constituents demonstrate a level of frustration when I come back.”
Womack expressed his own frustration that the Trump administration has focused mainly on negotiating with lawmakers who came out against the bill the first time around. Vice President Mike Pence, for instance, huddled with the Freedom Caucus on Monday night to pitch the idea of the EHB waivers. White House budget director Mick Mulvaney joined a meeting on Capitol Hill Tuesday afternoon with leaders from both the Freedom Caucus and the moderate Tuesday Group to gauge the potential for a deal.
“No one has come up to me and said, ‘Hey, how can we make this thing better for you,'” complained Womack.
Asked if the administration was pandering too much to the Freedom Caucus, Womack said: “There’s a limit to how much that can take place before you start sending the message that if you really want something, whip no or undecided, and then they’ll come to you. I don’t like playing that game.”
As support within the Republican conference for the first Obamacare repeal bill foundered in March, just a few weeks after the bill was unveiled and rapidly marked up, President Trump issued an ultimatum: no more negotiations, either pass the bill now or leave Obamacare in place indefinitely. When critics of the bill refused to budge, he and his aides singled them out in social media rants and threatened to unseat them in the 2018 midterm elections. Those targeted by these attacks laughed them off and even fundraised off of them. A couple weeks later, the president returned to trying to cut a deal.
“He’s an artful negotiator. But negotiating in the civilian, business world is much different than negotiating with this establishment,” Womack said. “He’s learning that.”
What has actually changed?
When the health care bill crashed and burned two weeks ago, Freedom Caucus members said it didn’t do enough to bring down premium costs, moderates worried it would screw over older people and people with disabilities, many lawmakers complained about a rushed process and accused leadership of literally hiding the bill, members prepared to vote without a CBO score, and the President made little to effort to sell the idea to the American people.
Nearly all of those factors remain in the bill’s second go-around.
“There’s nothing fundamentally different or inherently different,” said Rep. Tom MacArthur (R-NJ), the co-chair of the Tuesday Group, when asked what has changed since the American Health Care Act was pulled from the House floor.
Rep. Bradley Byrne (R-AL), who sits on the steering committee of the Republican Study Committee, said the changes being debated are “of a minor nature to the same bill we didn’t vote on two weeks ago.”
The CBO concluded that passage of that original bill—which polled at a dismal 17 percent approval rating before it was scuttled—would have insured 24 million fewer people than leaving Obamacare in place.
Byrne, who said he was willing to work through the April recess if necessary to pass the revised bill, told reporters Tuesday: “The members of our conference want to get this done before we go home.”
But others urged patience and consensus-building, pointing to the failed rush to pass the first bill.
“One of the lessons we learned from this process is to let it be slow and deliberate and give everyone a chance to try to bring their ideas to the table,” said Rep. Kevin Brady (R-TX), the chairman of the Ways and Means Committee.
Tierney Sneed contributed reporting.