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 reunite 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 and hard-right Freedom Caucus head Mark Meadows — 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 1” but that has remained bogged down nearing the 100th day of his presidency, a key milestone.
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 under 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 so-called limited waivers to opt out of Obamacare’s standards setting minimum benefits that health plans must offer and a requirement — called community rating — forbidding insurers from charging different prices to people who are the same age. Both are provisions that the GOP’s ultraconservatives have pushed to eliminate as part of the repeal effort, deriding any bill that falls short of that “Obamacare Lite.”
At the same time, the deal would maintain several Obamacare protections supported by centrist Republicans, including the prohibition on denying people coverage based on pre-existing conditions. It would also force states who opt out of the community rating rules to set up separate insurance pools, known as “high-risk pools,” where people priced out of the private market could go to purchase coverage.