Health Care Vote Remains Uncertain

May 3, 2017

The White House is hoping that the House will move before the end of the week to overhaul the U.S. healthcare system with another attempt at repealing and replacing the Affordable Care Act (ACA), though Republicans still appear divided and no vote has been scheduled. House leadership is trying to prevent a repeat of when their first effort failed in March due to lack of enough votes to secure passage.

In order to make good on a key campaign promise, there has been a lot of talk and significant pressure from the Trump Administration to act quickly in the coming days, with Vice President Mike Pence spending time on the Hill, focused on garnering support from lawmakers. However, nearly 20 Republican moderates and centrists, have added their names to the “no” column, and at the same time, those “undecided” has grown to at least two dozen. House Republicans, who can only lose 22 votes and still pass the bill, are planning a May 4 members-only meeting to discuss the repeal effort. While top Republicans insist Speaker Paul Ryan’s (R-Wis.) leadership team is close to reaching the 216-vote threshold needed for passage, their job is becoming tougher by the day, as more lawmakers publicize their opposition to the latest version of the bill.

Since most concerns stem from the pre-existing conditions protections in the bill, the leadership team has been emphasizing the protections in the bills, including a requirement that states that opt out of the ACA regulations create risk pools to help pay the premiums for those with pre-existing conditions. Leaders are also reminding members that, under the bill, insurance companies could only charge people with pre-existing conditions more if they have a gap in coverage. If they remain on insurance, they cannot be charged more than a healthy person.

More specifically, the newest iteration of the bill, as crafted by Rep. Tom MacArthur (R-N.J.), will reinstate essential health benefits as the federal standard and keep the key provisions of the original American Health Care Act (AHCA) bill, which was scuttled last month after the measure lacked enough votes to pass it.

The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have wanted. As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states.

Among the provisions maintained are guaranteed coverage, community-rating rules, coverage for preexisting conditions, and allowing dependents to remain on their parents’ health-care plan until the age of 26. But, in an attempt to reconcile the desire for greater coverage with conservative concerns about the ACA’s regulations and ensuing premium hikes, the amendment will also offer states the option of obtaining limited waivers for some of the AHCA’s requirements.

States could seek these waivers for essential health benefits and community-rating rules, except for those regarding gender, age, and health status (with the exception of states with high-risk pools). States can only access these waivers if they intend to do so for the purpose of reducing premium costs, increasing the number of people insured, or otherwise benefiting the state’s public interest.

Leadership is operating under a time crunch. The House is scheduled to break for a one-week recess starting May 4, and Republicans are afraid that they could lose even more momentum during the break. Some are talking about canceling the recess, though Republican leaders have not yet decided how to proceed.