by Adam Cancryn · April 20, 2017
President Donald Trump and some administration officials have threatened to cut off Obamacare cost-sharing subsidies to get Democrats to the table on a replacement plan. | Getty
The text of a new bill is likely to circulate Friday or by the weekend.
UPDATE: 12:25 p.m.:
Senior White House and Republican congressional leaders are planning another health care showdown next week as they seek again to pass legislation to repeal and replace the Affordable Care Act.
The text of a new bill is likely to circulate Friday “or by the weekend,” White House officials say, with intentions to have a vote by midweek before the president reaches his 100-day mark.
The White House believes they are “close” to having the votes, one senior official said, but “people don’t want to commit without seeing the text.”
House Republicans are outlining a new deal that could revive their bid to repeal Obamacare — and set up an all-out sprint to make concrete progress on health care amid the specter of a government shutdown.
The flurry of activity just days before Congress returns to Washington aims to unite the GOP behind Speaker Paul Ryan’s embattled American Health Care Act, offering concessions meant to win over the party’s moderate and conservative wings.
The deal — brokered by centrist Tuesday Group co-chair Tom MacArthur (R-N.J.) and hard-right Freedom Caucus head Mark Meadows (R-N.C.) — proposes giving states more flexibility to opt out of major Obamacare provisions, while at the same time preserving popular protections like the law’s ban on discrimination against people with pre-existing conditions.
It remains unclear whether the proposal can succeed in shifting any votes — President Donald Trump and leaders were forced to abandon a planned vote last month in the face of intraparty rebellion. They’ve since struggled to find a path forward, and even the deal being floated now relies largely on rehashing concepts lawmakers previously rejected.
But Trump has made clear he wants progress fast on health care repeal — a campaign promise that he said would be completed on “Day One” but that has remained bogged down nearing the 100th day of his presidency, a key milestone. On Wednesday, Ryan, in London, said Republicans are putting the “finishing touches” on a health care proposal.
The renewed effort also comes just days before the high-stakes deadline over funding the government or facing the politically risky scenario of shutting it down over one of several contentious issues — including whether Republicans will fund a key Obamacare subsidy program, financing for Trump’s border wall and boosted military spending, among others.
Trump and some administration officials have threatened to cut off Obamacare cost-sharing subsidies — a decision that would wreak havoc on the Obamacare insurance exchanges — to get Democrats to the table on a replacement plan.
Those subsidies, which are at the center of a court battle begun during the Obama administration, help lower-income people pay medical bills and insurance deductibles. Taking them away would prompt insurers to either flee the market or severely hike premiums to cover those costs. Despite calls from the health care industry, business groups and Democrats to continue the payments, the White House has yet to tip its hand.
According to a draft of the tentative deal obtained by POLITICO, the latest proposal would allow states to apply for “limited waivers” that would undermine Obamacare’s protections for pre-existing conditions. Under these waivers, states could opt out of Obamacare standards setting minimum benefits that health plans must offer and a requirement — called community rating — forbidding insurers from charging different prices to people based on health status. Both are provisions that the GOP’s ultraconservatives have pushed to eliminate as part of the repeal effort, contending that these coverage mandates drive up the cost of insurance.
States opting out of the community rating rules would be forced to set up separate insurance pools, known as high-risk pools, where people priced out of the private market could purchase coverage.
At the same time, the deal would allow states the option to maintain insurance protections, supported by centrist Republicans, including community rating.