- The Washington Times - Thursday, May 4, 2017

Rep. Robert J. Wittman was adamant back in March: The Republican health care bill didn’t protect Medicare and Medicaid, cut health care costs or empower individuals enough to earn his vote.

But on Thursday, the Virginia Republican joined 216 of his colleagues in passing a slightly altered version of the repeal-and-replace bill, delivering a huge victory to congressional party leaders and President Trump.

“I just spoke with folks in the district,” Mr. Wittman told The Washington Times. “I reached out to a lot of folks there, got their perspective on things, talked to them. It really was about my interactions with folks back home and their thoughts on this.”

He was one of about two dozen Republicans whose switch from “no” to “yes” sealed the victory for his party, reviving a pledge to repeal the 2010 Affordable Care Act. It was a major reversal from March, when Republican leaders were forced to call off a vote at the last moment after realizing they were about to face an embarrassing defeat on the House floor.

At the time, a large group of conservatives said they couldn’t back the bill because it left too much of Obamacare intact. A smaller group of centrists, meanwhile, fretted that Americans would lose coverage funded by Obamacare.

Analysts said the defeat landed at the feet of Mr. Trump, the self-proclaimed deal-maker who wasn’t able to get it done.

Five weeks later, he and House Republican leaders made it happen.

Lawmakers said the winning coalition was cobbled together through changes to the bill and by making other promises.

Rep. Paul A. Gosar, Arizona Republican and a member of the conservative Freedom Caucus, flipped to “yes” after the administration promised him that the Senate would vote on legislation he wrote to apply federal antitrust laws to health insurance and bolster competition.

The biggest change was a deal struck between Rep. Mark Meadows of North Carolina, a leading conservative, and Rep. Thomas MacArthur of New Jersey, a member of the Tuesday Group, composed of moderate Republicans.

With Mr. Trump and Vice President Mike Pence cheering them on, the two men worked out a deal to give states more flexibility to ditch Obamacare’s strict coverage mandates, then pour tens of billions of dollars into high-risk pools to try to ensure tough cases aren’t left without insurance.

Other side deals were needed, too.

After Rep. Fred Upton of Michigan, a onetime point man for Obamacare repeal, fled the bill this week, Republican leaders enticed him back with an infusion of an additional $8 billion for the risk pools.

Rep. Daniel Webster of Florida said he became a “yes” vote after Republican leaders agreed to lift a cap on Medicaid funding for nursing home beds.

About 70 percent of Florida’s Medicaid budget is taken up by older people — unlike in other states, where the health care portion for younger people soaks up the most funds. But Mr. Webster pushed back against the notion that the provision was a sweetheart carve-out for his state.

“I wasn’t trying to do anything. The fix won’t be anything just concerning Florida; it will apply to anybody. I just said we were the biggest at risk,” he said.

Seven years ago, during the original Obamacare debate, Democrats were tarred with accusations of special deals such as the “Cornhusker kickback” — an enticement to win the support of Sen. Ben Nelson, Nebraska Democrat.

Rep. Mark E. Amodei, a Nevada Republican who opposed the first version of the bill in March because he feared it would disrupt Medicaid, said he switched positions after talking with the health secretary, the Medicaid administrator, Mr. Pence and congressional leaders.

Mr. Amodei said in a statement that they convinced him the original bill did enough to protect Nevada’s enrollees and the state budget.

“Accordingly, I have concluded that the potential for Nevada deficits or expanded Medicaid enrollees being kicked off of Medicaid will be avoided,” he said.

Rep. David Young, an Iowa Republican who had been listed as an opponent of the bill in March, was jolted by news this week that yet another insurer was pulling out of the Iowa exchange market under Obamacare, meaning 94 of the state’s 99 counties might not have had any options next year.

“It should concern all Iowans, and further highlights the need for action because lack of access to health care coverage is health care denied,” he said in a statement.

He said he was also swayed by the amendments boosting the risk pools to cover those with pre-existing conditions.

The deal-making ended up costing some votes. Rep. Mike Coffman, Colorado Republican, negotiated with Mr. Trump and Mr. Pence as well as House Speaker Paul D. Ryan, but in the end said there were just too many questions for him about the pre-existing conditions.

“In my conversations with House leadership and the administration over the last 72 hours, I made it clear that additional language was necessary to protect this vulnerable group,” he said.

He also said he was wary of voting without having a final score from the Congressional Budget Office detailing the costs and effects, including how many fewer people are estimated to have coverage. An earlier CBO report said 24 million fewer people would be on plans in a decade.

Those Republicans who did switch have now become prime targets for Democrats and their allies.

“We have one message for Virginia Rep. Rob Wittman, who voted today to take away health care from more than 24 million Americans and end vital protections for those with pre-existing conditions: See you at the ballot box,” said Anna Galland, executive director of liberal pressure group MoveOn.org.

Mr. Wittman said he couldn’t point to any single reason he switched from “no” to “yes” but that part of his process with getting more comfortable with the bill was explaining it to his constituents.

“I think there is some confusion there about pre-existing conditions — much of it is an incorrect perception about what is going on. I think there have been some things done to fix that, and I think what we’ve done is that we have addressed four of the five major cost drivers,” he said.

“So, as I have talked to folks, you know, they look at it and say, ‘Listen, prices continue to go up, choices continue to go away, we want you to fix it to make sure costs come down, choices come back, you protect pre-existing conditions,’ which I think the bill does,” he said. “Now it is not perfect, but I don’t think there is any situation which as complex as where we are right now that you are going to have the perfect solution.”

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