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White House, GOP Leaders at Odds Over ACA Bill Vote Plans

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(Bloomberg) — The Trump White House and congressional Republicans were at odds Thursday over whether to try for another vote on changing the Affordable Care Act next week, indicating that neither side had a clear strategy for moving on one of the president’s central campaign promises.

A White House aide said President Donald Trump’s administration expects the House to vote soon after lawmakers return from recess on Tuesday, and draft language could be circulated as soon as Thursday night. Success would give the president a legislative victory to boast about before his 100th day in office April 29.

But a senior House Republican aide said that revised language for a bill hasn’t been agreed on and there’s no text yet for lawmakers to review. There’s no target date for a vote, whether next week or at any future time, the aide said.

Related: Government Shutdown Could Roil Markets, Tax Cuts Still Doable: Friedman)

Trump said that he’s not tied to getting the health bill finished by next week. Speaking at a White House news conference with Italian Prime Minister Paolo Gentiloni, Trump said he wants Congress to work on health care legislation and a bill to fund the government.

“It took Obamacare 17 months; I’ve been negotiating this for two months,” he said. “I’d like to say next week, but I believe we will get it, whether it’s next week or shortly thereafter.”

House Speaker Paul Ryan said a day earlier while on a trip to London that lawmakers were negotiating “finishing touches.”

Repeal of the Affordable Care Act was a major Trump campaign promise and a longtime goal of House Republicans. But a vote next week may risk another big political embarrassment like the one in March, when Trump and Ryan abruptly scrapped a vote on an ACA change bill, the American Health Care Act bill, for lack of Republican support.

“The political ramifications of trying to pass a bill and failing is just one piece of this,” said Joshua Huder, a congressional expert at the Government Affairs Institute at Georgetown University. “Members may be desperate to give their constituents something in return for having the majority for four months.”

“That pressure to try may be more important than the consequences of falling short again,” he said.

House Republicans have been away from Washington for the past two weeks and, for some, town halls held in their districts have drawn anger from constituents over the failed health care proposal, which the Congressional Budget Office estimated would result in 24 million people losing or dropping health insurance coverage over a decade. Some Republicans have distanced themselves from that plan.

Weekend Business

House Republicans plan a conference call Saturday with Ryan and other leaders to discuss the health care bill as well as spending legislation to keep the government operating when current funding expires at the end of the day April 28.

Some proposed changes to the AHCA bill were circulating among members, including an amendment co-sponsored by Rep. Tom MacArthur, a New Jersey Republican and co-chairman of a group of House moderates. His amendment is being depicted as a compromise with conservatives in an effort to draw enough support for passage.

The amendment, reported earlier by Huffington Post, would let insurers charge higher premiums for people with pre-existing conditions in states that get a waiver. To obtain the waiver, states would have to provide sick people priced out of commercial insurance access to a so-called high-risk pool run by the federal government, or establish their own risk pool, and satisfy other conditions.

Nonessential Benefits

MacArthur’s proposal would also allow states to opt out of the ACA requirement that insurance policies cover the benefits in the ACA essential health benefits package, such as maternity care. Those provisions would create cheaper insurance products by allowing companies to effectively exclude high-cost people and expensive care.

But the language may not be embraced by all of MacArthur’s fellow House Republican centrists. The underlying bill also appears to be well short of the 50 votes needed to pass in the Senate.

House Minority Leader Nancy Pelosi, a California Democrat, said in a statement that the “Republicans’ latest plan is to expose Americans with pre-existing conditions to staggering new health costs.” Democrats have refused to aid in dismantling former President Barack Obama’s biggest domestic achievement.

As the Republican fight over health care has dragged on, the ACA has become more popular with the public. In a Quinnipiac University poll conducted April 12-18, only 36% of voters said Republicans should try again to repeal the ACA, and 60% said lawmakers should “move on to other issues.” Sixty-five percent of those polled said they disapproved of the way Trump was handling the issue.

Revenue Threat

The earlier Republican proposal sought to pull hundreds of billions of dollars out of the health system by winding down the ACA Medicaid expansion program and limiting ACA subsidies, which would threaten revenue for hospitals, doctors and insurance companies. Much of the savings would be used to pay for tax cuts.

Trump demanded a vote on the measure, but Ryan pulled it from the House floor hours before a scheduled vote on March 24 for lack of support from his fellow Republicans. The speaker admitted he was disappointed but insisted Republicans would try again.

Under White House prodding two weeks later, Republicans added a provision to the bill that would give health insurers $15 billion over nine years to subsidize the care of high-cost patients.

Separately, Treasury Secretary Steven Mnuchin said Thursday that stumbles on health care haven’t derailed plans to complete a major overhaul of the tax code by the end of the year.

“Whether health care gets done or doesn’t get done, we’re going to get tax reform done,” Mnuchin said at a conference in Washington.

— Read 3 Opportunities in the Health Gap Market on ThinkAdvisor.


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