House Republican leaders revived their Obamacare repeal bill Thursday, modifying the plan to earn the support of wary conservatives and setting the table for a showdown when Congress returns from a two-week spring break.
Just weeks after they bungled their first attempt at passage and declared Obamacare the law of the land for the foreseeable future, Republican leaders reversed themselves again, saying they think they have found a way to entice the warring factions within their party back to the table.
Their latest proposal calls for the government to spend an additional $15 billion to subsidize premiums for sicker customers, allowing insurers to charge less for healthier people.
“This brings us closer to the final agreement that we all want to achieve,” House Speaker Paul D. Ryan, Wisconsin Republican, said at his weekly press conference. He was joined by 20 or so lawmakers from the disparate Republican factions, a bit of theater designed to exude party unity.
Lawmakers held up the measure as a hopeful — if incremental — development after the latest round of talks failed to bridge rifts within the Republican Party over a way forward.
“Repeal and replace of Obamacare is not dead,” said Rep. Mimi Walters, California Republican.
For now, Republicans will leave Capitol Hill with nothing to show their constituents on health care.
“At this point, I am willing to stay to get it done, but I am not concerned. My district loves me,” said Rep. Mark Meadows, North Carolina Republican and chairman of the Freedom Caucus, which angered President Trump by withholding its support for the Obamacare repeal bill.
Racing toward a self-imposed deadline last month, Republicans tried to pass a bill that would have replaced Obamacare’s generous subsidies with a Republican-written tax entitlement designed to help people afford coverage if they don’t have plans through their employers. The bill also would have restructured Medicaid and canceled Obamacare’s individual mandate.
Conservatives said the bill was too similar to Obamacare, while moderate Republicans balked at an analysis that showed some 24 million fewer people would have coverage under the Republican plan a decade from now.
Republicans were 10 to 15 votes shy of building a majority and pulled the bill from the floor, admitting to an embarrassing defeat.
Along the way, they even managed to make Obamacare look good. Polling suggests the Affordable Care Act is more popular than ever. Gallup says a majority of Americans support the law — a first since the company started asking about it in 2012.
Three in five people told the nonpartisan Kaiser Family Foundation that Mr. Trump and congressional Republicans will be responsible for any health care problems now that they are in charge.
Rep. Chris Collins, New York Republican, said the failure to act on health care does not send a positive signal on how House Republicans will handle other issues, including tax reform. He also said members of the House Freedom Caucus will regret their early opposition.
“What are they going to tell their constituents in six months or next year? Because they are going to wear it,” he said. “They can try like heck to point fingers any which way they can. Those fingers are pointing back at themselves.”
Now, the holdouts are pondering the changes.
Freedom Caucus members say the White House could get most of them to approve a bill by allowing states to seek waivers from regulations that require health insurers to cover a minimum set of benefits, charge sicker consumers the same amount as healthy people in a given geographic area and offer policies regardless of health status.
“If those offers that were made over the last couple days actually appear in the legislation, the majority if not almost all of the Freedom Caucus will vote for this bill,” Mr. Meadows said Thursday during a Politico Playbook interview.
House Republicans pledged to avoid changes that would force sicker consumers to pay more or roll back protections for people with preexisting conditions, however, so the Freedom Caucus’ demands are a tough sell among the rest of the conference.
They also might spook Senate Republicans, who cannot afford to lose more than two votes from their 52-seat majority.
The Freedom Caucus says its ideas can work with the type risk-pooling proposed Thursday by Rep. Gary J. Palmer of Alabama and Rep. David Schweikert of Arizona. Their four-page amendment would give the Health and Human Services Department wide latitude over how to disperse the $15 billion to insurers, including which patients would be covered.
The federal government would oversee the program for three years before it is handed off to the states.
Members applauded the idea in principle — Republicans have long embraced high-risk pools — though they said they needed time to digest the changes in their home districts.
“We’re making progress,” said Rep. Patrick J. Tiberi, Ohio Republican. “We made progress in this Palmer amendment; we’ll continue to try to make progress when we get back. We’re going to be talking over recess.”
Some Republicans said they are ready to cut their recess short if a deal is struck.
“If we get white smoke, we’ll all be advised of that and act accordingly,” said Rep. H. Morgan Griffith, Virginia Republican. “I don’t know that it’s a probability, but it’s always a possibility.”
Democrats carped from the sidelines, saying Republicans are casting about for answers.
“There was no vetting at all, no process whatsoever. Just a couple of good ol’ boys with a typewriter saying, ‘Maybe this will work,’” Rep. James P. McGovern, Massachusetts Democrat, told the Rules Committee. “I guess what my Republican friends want is to have something to point to before the two-week recess. But this isn’t a solution.”
Policy analysts said Republicans are underestimating the cost of subsidizing pools of high-risk consumers.
Thursday’s proposal “could be very helpful to reducing insurance premiums and keeping insurers in the game, if it were adequately funded,” said Timothy Jost, a law professor at Washington and Lee University who closely tracks the health care debate. “It isn’t at this level.”
Larry Levitt, a senior vice president at the Henry J. Kaiser Family Foundation, tweeted that “$15 billion over 9 years is definitely not enough to make a meaningful difference in premiums or market stability.”