Washington
Pence spent much of Tuesday on Capitol Hill meeting with key groups of lawmakers, as well as with House Speaker Paul Ryan, R-Wis., a day after visiting separately with conservative hard-liners and moderates to gauge the potential for a revamped version of legislation that collapsed last month.
The crux of the new proposal would be to allow states to seek exemptions from certain mandates established under the Affordable Care Act — including a requirement that insurers cover 10 “essential health benefits” as well as a prohibition on charging those with pre-existing medical conditions more than the healthy.
While the largely behind-the-scenes effort generated optimistic talk, no clear path has emerged toward House passage of the Republican bill. On Tuesday evening, key players said they were still waiting to see new proposals in writing, and some lawmakers said they were wary of rushing the process.
“There is a value sometimes to the vetting process,” said Rep. Mark Sanford, R-S.C., a member of the hard-right House Freedom Caucus, a group targeted by President Trump last week for its opposition to the bill. “That having been said, we’ll see what comes our way.”
Pence was scheduled to attend a meeting late Tuesday in the Capitol with leaders of key House GOP factions, including the Freedom Caucus. Ryan and other House leaders were not expected to participate, and it was unclear late in the day whether the legislative text of the proposals would be available for the various parties to review.
Rep. Mark Meadows, R-N.C., the Freedom Caucus chairman, said before the meeting that his group was still seeking broad relief from the ACA’s insurance mandates.
“We’re down to just a few fundamental issues that we are asking for repeal of,” he said. “Bottom line … we’re asking for one thing: Premiums for the people we serve have to come down, and if they don’t come down, we will have failed.”
Others — both Republicans and Democrats — objected to the idea of undoing protections for people with pre-existing conditions. That ACA requirement, known as “community rating,” prohibits insurers from segregating healthy subscribers from sick ones or charging the latter higher prices. Instead, they may vary their prices based only on age, geographic location and tobacco use, allowing the premiums paid by the healthy to subsidize the sick.
Sen. Patty Murray, Wash., the ranking Democrat on the Senate Health, Education, Labor and Pensions Committee, said in a statement that the proposal would “give power back to the insurance companies, increase costs, and undermine care for people with pre-existing conditions.”
Rep. Tom Reed, R-N.Y., a member of the Ways and Means Committee, called the provision “a very significant reform” that he was concerned about rolling back, even if states would have to be granted a waiver.
The new proposal also could allow states to strip back other mandates, including requirements that insurers provide coverage for mental-health care, substance abuse treatment, maternity care, prescription drugs and more.
The changes were largely calibrated to win over the hard-liners in the Freedom Caucus, who blame the mandates for driving up insurance premiums. But the proposal also takes into account the qualms of moderates who are wary of undermining the ACA’s key reforms by requiring states to apply for waivers and to justify why insurers should not be required to provide certain coverage.
Those moderates helped defeat the original version of the American Health Care Act two weeks ago, largely out of concern over a similar provision governing essential health benefits. And advocates of the new proposal appeared to be making little headway on Tuesday.
“While we haven’t picked up any votes yet, this concept is already showing signs of losing a ton of them,” said a House Republican leadership aide, who requested anonymity to speak more candidly.
Ryan said on Tuesday that the talks were in the “conceptual stages” and did not commit to a timeline for resolving the differences that sank the bill last month. “It’s important that we don’t just win the votes of one caucus or one group,” he said.
Pence sounded a similarly nonspecific note, telling a gathering of business executives at the White House that he and President Donald Trump “remain confident” that Congress would repeal and replace the ACA.
White House Press Secretary Sean Spicer offered no timetable either, saying only that administration officials would continue meeting with lawmakers in hopes of advancing the bill.
“The president would like to see this done if we can get a deal,” Spicer said. “I’m not going to raise expectations, but I think that there are more and more people coming to the table with more and more ideas about how to grow that vote.”
Though aides said Trump has been in touch with both House and Senate members in recent days, he was playing a much less visible role in deliberations than in the days leading up to the aborted vote. Aides said that was partly due to a string of visits this week from three world leaders.
Pence, White House Chief of Staff Reince Priebus and Budget Director Mick Mulvaney began the two-day push to revive the repeal effort late Monday, with a trip to Capitol Hill to attend a Freedom Caucus meeting. Meadows said they offered a “solid idea” in that meeting to build a potential compromise around.
But both Freedom Caucus members and moderates emerged from a Tuesday morning House GOP conference lacking clarity on the path forward.
“Right now there are really just discussions, there’s no deal in the works, there’s been no deal on anything,” said Rep. Justin Amash, R-Mich., a Freedom Caucus member.
Rep. Steve Womack, R-Ark., a House leadership ally, said he didn’t get the sense that a compromise was near.
“I didn’t get any vibe this morning of ‘hold the phone, we may be close to a deal here,’ ” he said. “There’s no white smoke coming out of any leadership office that I’m seeing,”
Meadows said late Monday that he expected that the proposal would be drafted into legislative text within 24 hours, but it remained unclear late Tuesday whether that effort was underway absent a broader accord on the underlying principles.
While addressing reporters, Spicer was asked if a deal that rolled back protections for pre-existing conditions would violate a campaign pledge by Trump. “We’re not there yet,” he said. “We’re having discussions.”
Two other moderate House members also said they remained opposed: Rep. Frank LoBiando, R-N.J., tweeted that he had “seen nothing in terms of reported possible changes to American Health Care Act warranting reconsideration.” And Rep. Leonard Lance, R-N.J., said changes to community rating would undermine protections for those with pre-existing conditions.
On the flip side, it was unclear just how many Freedom Caucus members could be swayed with the softened provision to give states the option of requesting exemptions to some of the ACA’s mandates.
“I don’t think that a long-term solution consists of allowing states to ask the federal government for waivers, because presidents change,” said Rep. Mo Brooks, R-Ala. “States ought to have as a matter of right the ability to determine what insurance policies for their citizens should contain.”
A health care industry official argued that the proposed changes to the bill appear to leave in place most of the core problems with the original bill and exacerbate others by making changes that would effectively make insurance either too expensive or too skimpy for sick people.
“To put it simply, this is making a bad bill worse,” said the industry official, who spoke on condition of anonymity in order to speak frankly. The official added that his industry is waiting to see the details of the revised bill before weighing in publicly: “You don’t want to rain on a parade until you know its headed into town.”
The flurry of activity on Monday and Tuesday raised some hopes that the closely watched legislation could be revived and passed through the House quickly.