Republicans made yet another change to their Obamacare replacement bill Wednesday, winning over two prominent holdouts and raising the prospects of a vote in the House this week before lawmakers head home for a week-long vacation.
President Trump and House leaders embraced a plan by Rep. Fred Upton, Michigan Republican, that provides $8 billion over five years to reduce premiums and out-of-pocket costs for people who’ve been seriously sick and then experience a gap in coverage — a sequence that would force them to pay more in states that waive certain protections baked into Obamacare.
Mr. Upton, a respected GOP voice on health policy, and Rep. Billy Long, a conservative Republican from Missouri, said the changes flipped them back into the “yes” column after their defection this week threatened to doom leadership’s push.
“My sense is that there are a number of folks that will come on board now that we have this,” Mr. Upton said.
Members of the archconservative House Freedom Caucus, for instance, said they would not revoke their support for the revised bill, which also lets states opt out of a series of “essential” health benefits, such as maternity and mental health care and prescription drugs.
GOP leaders wouldn’t say Wednesday whether they’ll force a vote this week, though House Majority Leader Kevin McCarthy did warn lawmakers not to leave before Thursday.
Republicans are treading very cautiously, after a tug-of-war between the conservative and centrist flanks of the party resulted in a failed attempt in March. Another false start could devastate the GOP’s seven-year push to repeal the 2010 Affordable Care Act.
The White House said Wednesday it still wants leaders to pin down the votes before acting, even as top officials openly pushed for a vote before they leave town.
Republicans say the law is collapsing on its own, and evidence continues to pile up.
Medica said it might pull out of the Iowa marketplace next year — a move that would leave much of the state without an insurer on the individual market. And Aetna, a major insurer, said it was pulling out of Virginia in 2018.
Democratic senators blamed Mr. Trump for sowing uncertainty in the markets, but the administration said it should push Democrats to join the effort to come up with a replacement.
“We are actually a point where if we don’t do something, some people in this country will have no options for coverage,” White House Press Secretary Sean Spicer said.
As it stands, leaders cannot afford to lose more than 22 GOP votes in the face of blanket Democrat opposition to a plan that guts President Obama’s signature achievement.
Many centrists are worried about significant coverage losses from reining in Medicaid funding and changes to Obamacare’s subsidy structure.
They’ve also criticized a waiver system the GOP is leaning on in its latest plan, saying it seems to renege on pledges to protect Americans with preexisting conditions. Under the amendment, states would be able to charge sicker consumers more than healthy ones, so long as states set up high-risk pool to pick up their higher costs.
States could already tap $115 billion in federal “stability” funding over 10 years for the high-risk pools and an additional $15 billion for a risk-sharing mechanism to pay for sicker consumers who could be priced out of the market.
Mr. Upton said his extra $8 billion would be an added incentive.
Democrats accused Republicans of hurtling ahead before the Congressional Budget Office weighed in on the latest changes, though they’re already unimpressed with Mr. Upton’s proposal.
“The proposed Upton amendment is like administering cough medicine to someone with stage 4 cancer,” Senate Minority Leader Charles E. Schumer said.
• Sally Persons contributed to this report.