Republican leaders are struggling to win over conservative Republicans without losing centrist Republicans. (Photo: Thinkstock)

(Bloomberg) — The conservative House Freedom Caucus that helped derail the GOP’s effort last month to attack the Affordable Care Act has formally endorsed a revised measure, potentiality giving it a new lease on life.

“While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health care costs,” the group said in a statement. “We look forward to working with our Senate colleagues to improve the bill.”

(Related: Stalled Health Bill Wins New Support From Conservative Holdouts)

The endorsement could help build support for a new vote as early as next week, but a number of moderate Republicans said they’re still opposed.

House Republicans have been under intense pressure to deliver on years of promises to repeal Obamacare, but GOP leaders weren’t making predictions of an imminent vote, despite renewed pressure from the White House as President Donald Trump approaches his 100th day in office on Saturday.

The new enthusiasm stems from an amendment that would give states the authority to apply for waivers from some of Obamacare’s requirements under certain conditions.

“It’s pretty much everything I was looking for in terms of concessions,” said Rep. Scott DesJarlais of Tennessee, a member of the Freedom Caucus who had opposed an earlier version.

House Speaker Paul Ryan told reporters Wednesday the amendment provides “a great way to lower premiums, give states more flexibility while protecting people with pre-existing conditions.” When asked whether the House will vote next week on the health care bill, he said, “We’ll see. We’ll vote on it when we get the votes.”

“We’re showing people the language now,” Majority Leader Kevin McCarthy of California said Tuesday. House Republicans held a closed-door meeting Wednesday where Rep. Tom MacArthur of New Jersey discussed his amendment.

Still ‘Cautious’

“Cautious,” said Rep. Phil Roe of Tennessee, a medical doctor, of the approach that House Republican leaders are taking. Rep. Steve Chabot of Ohio said everyone is proceeding quietly so that nothing happens “to blow everything up.”

But an influential Republican moderate, Charlie Dent of Pennsylvania, said the changes don’t soften his opposition to the GOP bill.

“The amendment as I understand it doesn’t change my position. I am still a no,” he said Tuesday.

Changes to the bill may also make it more difficult to pass the Senate. “It will be harder for the Senate to get 51 Republicans,” Republican Sen. Roy Blunt of Missouri, a former House majority leader and longtime whip, said Wednesday.

The White House, which has been involved in discussions about the changes, is still eager to resurrect the health care bill.

“We’re not going to overpromise anything; when the votes are there, the speaker will bring it to the floor but no sooner than that,” White House Chief of Staff Reince Priebus told reporters late Tuesday. He said he didn’t know if that might be this week or next.

Repeal of the Affordable Care Act was a major Trump campaign promise and a longtime goal of House Republicans.

Growing Support

“We probably had about half of the members of the Freedom Caucus in the first go-around,” White House legislative affair director Marc Short told reporters Tuesday. “With this amendment, I’d like to think we have greater than 80% — we are very confident in that.”

Short said he still thinks they could get the health care bill passed before the GOP tax bill is introduced in the next four to six weeks.

Much of the renewed optimism stems from new support within the House Freedom Caucus, a group of about three dozen staunch conservatives.

Opposition from many inside that group, who wanted a more robust repeal measure, along with skepticism from many Republican moderates, was pivotal to Ryan’s decision last month to abruptly scrap a vote on the bill for lack of votes.

On Tuesday, members of the Freedom Caucus who previously didn’t support the bill, including Rep. Dave Brat of Virginia, and DesJarlais, said they now support the measure.

State Waivers

The amendment would allow insurers to charge higher premiums to 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, and satisfy other conditions.

Even Mo Brooks of Alabama, a conservative who opposed the previous version, said he’s considering the amendment.

“I believe there will be some movement,” he said. “I don’t know how much.”

Dent, however, said the bill doesn’t provide a “soft enough” landing for states that expanded Medicaid, and still doesn’t provide sufficient support to help low-and middle-income people, in his view.

Pressure from the White House, combined with fresh support from conservatives, could put intense pressure on moderates to vote for the bill. But those moderates in swing districts, unlike the members of the Freedom Caucus, could end up losing their seats if the repeal bill continues to remain unpopular.

“I will vote my conscience,” said Rep. Leonard Lance of New Jersey, who said he also remains opposed.

—With assistance from Anna Edgerton, Shannon Pettypiece, Margaret Talev, Erik Wasson and Arit John.

— Read Trump says GOP must pass AHCA or risk losing seats on ThinkAdvisor.

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.