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House GOP Leaders Tweak Health Care Proposal

Action before recess won’t make bill ready for a vote

House Speaker Paul D. Ryan has announced an amendment to the GOP’s health care bill that would create a high-risk pool for people with pre-existing conditions. (Bill Clark/CQ Roll Call file photo)
House Speaker Paul D. Ryan has announced an amendment to the GOP’s health care bill that would create a high-risk pool for people with pre-existing conditions. (Bill Clark/CQ Roll Call file photo)

House Republican leaders seeking to change the narrative on the health care talks announced plans to tweak their proposal on Thursday before members leave for a two-week recess, a move they touted as “progress.”

But they acknowledged it does not make the legislation ready for a vote.

Speaker Paul D. Ryan moved up his weekly news conference by a few hours Thursday to announce the amendment, which would create a high-risk pool that Republicans say would help insurers cover costs of individuals with pre-existing conditions and keep premiums lower for healthy individuals. The amendment passed the House Rules Committee, 9-2, early Thursday afternoon.

“We have more work to do, and those conversations continue to take place and they really show promise,” the Wisconsin Republican said at his news conference. “But this amendment alone is real progress and it will help us build momentum for delivering on our pledge to the country.”

The quick action was unnecessary given that the bill still lacks the required support to pass. It’s unclear if the change will move any of the previously declared “no” votes to “yes.”

Making an impression

But GOP leadership wanted to leave for the break with the impression that Republicans are still capable of fulfilling their campaign promise to repeal and replace the 2010 health care law.

“I think they wanted to leave probably with a sense of optimism that things are back on track and that they’re moving in the right direction,” Rules Committee member Tom Cole said when asked why the panel didn’t just take up the amendment when they return from recess.

“I think that’s the wise thing to do. I’m hopeful that this is a good sign,” the Oklahoma Republican said.

Members from across the conference did indeed characterize the amendment as a positive.

“It doesn’t complete the task, but it’s a good step in the right direction,” House Freedom Caucus Chairman Mark Meadows said.

New Jersey Rep. Tom MacArthur, co-chairman of the moderate Tuesday Group, said he didn’t know if the amendment would win any votes on its own.

“I don’t think it loses any,” he said. “More importantly, it’s a good idea … that helps people, so it belongs in the bill.”

The high-risk pool amendment seems to have found consensus among Republicans.

But a proposal that members have yet to coalesce around is allowing states to apply for a waiver to opt out of certain insurance regulations, like the so-called community ratings that require insurance companies to offer the same prices to everyone, regardless of their health status.

Vice President Mike Pence had pitched the waiver idea as a potential compromise to the Freedom Caucus, which had pushed to repeal the community ratings regulation.

Many moderate members have panned the proposal. And on Wednesday, Chief Deputy Whip Patrick McHenry said adding the community ratings waiver to the bill would lose more votes than it would gain.

Opting out

But conservatives still see the ability for states to opt out of the regulations as key to winning their support for the legislation. The high-risk pool amendment was crafted by Freedom Caucus members and is designed to ensure that people with pre-existing conditions and other illnesses would still be able to afford coverage even without the community ratings regulation.

Freedom Caucus member Scott DesJarlais said the proposals complement one another. 

The Tennessee Republican offered this example: “If all you guys are healthy and I have cancer, which I did, right now, you’re all going to pay the same as I did. If we take out community ratings, you get a better premium. Mine is more expensive, but if I can’t afford it, I will get help through this other risk pool.”

Asked about the waiver proposal during the news conference, Ryan declined to offer an opinion. But he did not shut the door to the idea.

“I’m not going to get into the particular details of the conversations that are going on,” he said. “But we believe that there are additional reforms and ideas that can do both things, protect people with pre-existing conditions and continue to lower premiums and give states flexibility so that more insurers can come into the marketplace.”

House Republican leadership and members say they are hopeful they can work through the remaining issues and get enough support to pass the bill. Several members said no meetings or conference calls had been scheduled during the recess yet but they expect negotiations to continue over the break.

In a memo sent to GOP members Thursday morning, House Majority Leader Kevin McCarthy suggested that leadership could bring members back from recess early to vote on the bill if the ongoing talks yield additional progress.

“I realize how important it is to keep up momentum so be assured that conversations will continue and we will keep in contact with you throughout the district work period,” the California Republican wrote. “Should we be prepared to advance our bill through the House in the coming two weeks, we will advise members immediately and give you sufficient time to return to Washington.”

Joe Williams contributed to this report.

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