Thread: Hard-Line Republican Caucus Backs Revised Bill to Repeal Obamacare

Hard-Line Republican Caucus Backs Revised Bill to Repeal Obamacare

By JENNIFER STEINHAUER and ROBERT PEAR
APRIL 26, 2017

WASHINGTON — The House Freedom Caucus, a group of hard-line conservatives who were instrumental in blocking President Trump’s plan to repeal the Affordable Care Act last month, gave its approval Wednesday to a new, more conservative version, breathing new life into Republican efforts to replace President Barack Obama’s health law.

Senior White House officials, led by Reince Priebus, the chief of staff, have relentlessly pressed Republicans to revive the health care push before Mr. Trump’s hundred-day mark on Saturday, and with conservatives falling into line, the bill has a chance to get through the House, possibly as early as Friday.

It was not clear whether conservative support for the revised legislation would be matched by losses in the center, especially among Republicans representing districts won by Hillary Clinton. But the rest of the House Republican Conference was left with a stark choice: Reject the measure and take the blame previously left at the feet of conservatives for undermining a central goal of the administration, or give it the nod, please voters who want a repeal, and risk taking a potentially fatal hit in the next election for approving a measure expected to leave tens of millions of Americans without insurance.

“Members went home and got an earful,” said Representative Tom Cole, Republican of Oklahoma, saying that voters were wondering, “Why can’t you get something done?” Mr. Cole said he was now “cautiously optimistic” that the measure could pass on the floor.

The latest proposal, drafted by Representative Tom MacArthur, a moderate Republican of New Jersey, would allow states to obtain waivers from federal mandates that insurers cover certain “essential health benefits,” like emergency services, maternity care, and mental health and substance abuse services, which many Republicans argue have driven up premiums.

It would also permit states to get waivers allowing insurers to charge higher premiums based on a person’s “health status,” if a state had a program to help pay the largest claims or had a high-risk pool where sick people could purchase health insurance.

To qualify for a waiver, a state would have to explain how it would advance at least one of five purposes: reducing average premiums for consumers; increasing the number of people with coverage; stabilizing the insurance market; increasing the choice of health plans; or stabilizing premiums for people with pre-existing conditions.

The House Freedom Caucus members, acutely aware that the White House and Republican colleagues blamed them for the failure of the earlier bill, were eager to shift the blame to more moderate members who may now reject the measure. And the biggest conservative pressure groups off Capitol Hill — Heritage Action, Club for Growth and Freedom Partners — dropped their opposition to the measure, known as the American Health Care Act.

“Over the past couple of months, House conservatives have worked tirelessly to improve the American Health Care Act to make it better for the American people,” Alyssa Farah, a spokeswoman for the House Freedom Caucus, said in a prepared statement. Because of those changes, she added, “the House Freedom Caucus has taken an official position in support of the current proposal.”

The group agrees to take an official position when 80 percent of its roughly three dozen members agree.

But what is good for the most conservative corners of the House is not necessarily going to please their colleagues, including the dozens who had already rejected a less-conservative version of the bill. Republican senators had been equally wary. “I think a better approach is to stabilize the insurance pool,” said Senator Bill Cassidy, Republican of Louisiana.

In effect, the more that the bill changes to get through the House, the less chance it has of surviving in the Senate, both because of Senate rules and because the provisions that conservatives have excised are popular.

A recent ABC News/Washington Post poll found that 62 percent of respondents supported nationwide minimum insurance coverage standards and just 33 percent would leave such standards up to the states. Among Republicans, 54 percent supported a nationwide standard for coverage of pre-existing conditions.

Republican senators from states that have expanded Medicaid under the Affordable Care Act said the new House bill did nothing to ease their concerns about the deep cuts to Medicaid that remain in the legislation.

“There’s still going to be some of us here in the Senate who would like to weigh in, particularly on Medicaid expansion, which is not part of the bill,” said Senator Rob Portman, Republican of Ohio.

Democrats assailed the latest proposal, saying it did nothing to help those who would be left without coverage under the repeal bill. By 2026, the number of uninsured people would be 24 million higher than under the current law, according to the nonpartisan Congressional Budget Office.

Democrats denounced one part of the new proposal that, they said, would protect health insurance for members of Congress. This provision, they said, guarantees that lawmakers would not lose “essential health benefits” and could not be charged higher premiums because of their health status. The group that helps elect House Democrats immediately unleashed internet ads in 30 Republican-held districts railing against the carve-out.

“The monstrous immorality of Trumpcare is perfectly encapsulated in House Republicans’ plan to exempt their own health coverage from the damage it will do to everyone else,” said the House Democratic leader, Nancy Pelosi of California.

Mr. MacArthur backed away from this part of his proposal on Wednesday. “Congressman MacArthur does not believe members of Congress or their staff should receive special treatment and is working with House leadership to make absolutely clear that members of Congress and staff are subject to the same rules, provisions and protections as all other Americans,” a spokeswoman said.

Mr. Trump, seeking a major legislative victory in his first 100 days in office, has been pressing hard to get a floor vote on a measure to repeal Mr. Obama’s signature health care law and to fulfill a campaign promise of most Republicans for the better part of a decade.

Vice President Mike Pence and other White House staff have been feverishly trying to get the most conservative members to support a bill, even one that is not viable in the Senate, and without the input of many moderate members.

But the effort may be creating momentum.

“The key is, all of us recognize we and the president made campaign promises to repeal and replace Obamacare,” said Representative Chris Collins, Republican of New York and a top Trump ally. “We, as a team, all recognize we need to get to yes.” He added, “I am guardedly optimistic.”

Speaker Paul D. Ryan said Wednesday that a new bill could come to the floor at some point if sufficient support surfaced. “We’ll vote on it when we get the votes,” he said.

As Republican leaders maneuvered toward a vote to repeal the Affordable Care Act, they were working to assure Democrats that the government would continue to subsidize out-of-pocket expenses for people buying insurance through the law’s online marketplaces. Democrats have threatened to hold up legislation to keep the government funded past Friday unless they get guarantees that the so-called cost-sharing reductions would continue.

House Republicans had successfully sued the Obama administration to stop the payments, arguing that the administration was illegally spending money that Congress had not explicitly appropriated. By Wednesday afternoon, Democrats appeared convinced that the money would keep flowing, a significant promise that should help reassure insurance companies as they decide whether to offer policies on the marketplaces in 2018.

Ms. Pelosi neared a declaration of victory on that front, and on efforts to block funding this year for Mr. Trump’s promised wall on the Mexican border.

“Our major concerns in these negotiations have been about funding for the wall and uncertainty about the CSR payments crucial to the stability of the marketplaces under the Affordable Care Act,” she said. “We’ve now made progress on both of these fronts.”

https://www.nytimes.com/2017/04/26/u...publicans.html

Pressure to repeal Obamacare is now on moderate Republicans

By MJ Lee, Tami Luhby and Lauren Fox, CNN
Updated 7:03 PM ET, Wed April 26, 2017

Story highlights

Moderate lawmakers signaled they were not eager to throw their support behind a new proposal
The proposal was aimed to bridge an internal divide in the GOP over health care reform

(CNN)Moderate Republicans in the House are suddenly feeling a whole lot of heat.

After weeks of hushed negotiations, GOP lawmakers this week touted a new amendment to a bill to repeal and replace Obamacare that was yanked from the House floor last month. That amendment won over the conservative House Freedom Caucus, which officially announced Wednesday that it would support the revised measure.

What this means is that the future of the GOP's efforts to dismantle Obamacare now overwhelmingly rests with moderate Republicans.

It's an unenviable choice for these lawmakers: Vote for an unpopular bill that experts say would hurt people with pre-existing conditions, or risk getting blamed for refusing to help their party repeal Obamacare, not to mention buck their own president.

Following a closed-door meeting of the Tuesday Group on Wednesday, moderate lawmakers signaled that they were hardly eager to throw their support behind the new proposal.

GOP Rep. Charlie Dent, a leader of the group, remains opposed to the legislation. Others like Rep. Frank LoBiondo also said they would not get behind the bill, citing concerns raised by constituents back home. Lawmakers returned to Washington this week after a two-week Easter recess.

"Closely reviewing changes, but see none of Medicaid concerns addressed. VERY REAL for #SouthJersey," LoBiondo tweeted Wednesday.

One moderate Republican who spoke anonymously put it this way to CNN: "I spent the whole work period hearing from people pissed about pre-existing conditions. This isn't helpful."

The development has also exacerbated already raw tensions between the conservative and moderates wings of the House.

"(It's) an exercise in blame shifting," Dent told reporters.

There is also griping about the decision by Rep. Tom MacArthur — a New Jersey moderate Republican -- to negotiate the amendment with Freedom Caucus Chairman Mark Meadows.

Before the Easter break, Dent said that members of the Tuesday Group had asked leaders of the group not to negotiate one-on-one with Meadows. Asked if he was upset with MacArthur or why MacArthur had struck a deal with Meadows, Dent told reporters that the question should be directed to MacArthur.

MacArthur defended his position to reporters Wednesday, saying the amendment was aimed at shrinking the gap between the two factions of the House GOP.

"The latest proposal I made was just trying to bridge this divide between people that are holding two important views: people that are saying 'we're not going to fix health care unless we bring the cost down, which means we have to give the states some flexibility,'" he said. "And, people that are saying 'we can't pull the rug out from under people that are vulnerable.' And, I agree with both of those. They are both right positions, and my amendment was just meant to bridge the divide between those two."

He added, "I think anybody who is wavering feels some pressure because the vast majority of our conference wants to pass this bill."

Moderates have serious grievances about the House GOP bill.

They are concerned about weakening the protections for people with pre-existing conditions -- a major reason that the MacArthur amendment is not sitting well with a significant swath of the House GOP conference.

Some members are also troubled that the House bill would severely cut back funding for Medicaid, which provides health coverage for many opioid addicts in their districts. Several GOP governors in states that expanded Medicaid to low-income adults were pushing representatives to revise these provisions in the House bill.

Another concern is the estimate that millions of people would lose their health care coverage as a result of the bill. The Congressional Budget Office projected that 24 million fewer people would be covered under an early version of the Republican bill, which did not include later changes to insurance reforms.

Moderates are also cognizant that many of their older constituents would not be happy with the bill, which allows insurers to charge higher premiums to those in their 50s and early 60s. The AARP has promised to inform all its 38 million members how lawmakers voted on the GOP health care bill.

These concerns are shared by the American public.

Only 17% of voters approved of the House bill, according to a Quinnipiac poll released last month.

A more recent Quinnipiac poll found that only 36% of American voters say Republicans in Congress should try again to repeal and replace Obamacare, while 60% say the Republicans should "move on."

Voters disapprove by a 65% to 29% margin of the way Trump is handling health care.

CNN's Phil Mattingly contributed to this report.

http://www.cnn.com/2017/04/26/politi...ill-moderates/

What percentage of Americans are covered by employer-provided health insurance?
Steve Hirsch, studied at Guilford College
Written 4 Feb 2016

Every year the Census Bureau issues a report about income and health insurance coverage. The latest report, issued in Sept. 2015, covered 2014 statistics. It says:

"Of the subtypes of health insurance, employment-based insurance covered the most people (55.4 percent of the population), followed by Medicaid (19.5 percent), Medicare (16.0 percent), direct-purchase (14.6 percent) and military health care (4.5 percent)."

Income, Poverty and Health Insurance Coverage in the U.S.: 2014

https://www.quora.com/What-percentag...alth-insurance

I wonder if the people in Congress are aware of these numbers? It seems like they aren't. Thought I would post it in case anyone from Congress reads our forum.

Related:

https://www.alipac.us/f9/gop-health-...ngress-346486/