WASHINGTON -- The White House is promoting a new health care proposal that the president insists will lower premiums and guarantee insurance coverage for people with pre-existing conditions.
Gary Cohn, chairman of President Donald Trump's economic council, said Monday that the overhaul appears to have enough votes to pass in the House of Representatives.
"This is going to be a great week," Cohn told CBS This Morning. "We're going to get the health care bill to the floor of the House, I'm very confident."
On the same show, Reince Priebus, White House chief of staff, predicted the health care bill would be "one of the fastest pieces of signature legislation to go through for a president since Roosevelt."
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But later Monday, White House press secretary Sean Spicer appeared to tamp down expectations, telling reporters, "We're not there yet," though the Trump administration is "getting closer and closer every day."
Under White House pressure, Republicans recently recast the original health care bill, which failed earlier this year.
In its analysis of the original version of the repeal-and-replace bill, the nonpartisan Congressional Budget Office said that average premiums in 2018 and 2019 "would be 15 percent to 20 percent higher under the legislation than under current law." But by 2026, it said, average premiums would be roughly 10 percent lower than under current law, in part by covering 24 million fewer Americans.
The revised bill's effects on those figures, if any, are unknown. Rep. Chris Collins, R-N.Y., a top Trump ally, said Republicans were not planning to seek a new cost-and-impact estimate from the Congressional Budget Office.
During an interview with Face the Nation on CBS that aired Sunday, Trump said: "Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be.'"
Trump has added that the measure has a "clause that guarantees" that people with pre-existing conditions will be covered.
But while the bill says people with pre-existing conditions will have "access" to insurance, it does not address affordability. The legislation would let states opt out of the requirement for standard premiums, under certain conditions. If a state maintains protections such as a high-risk pool, it can allow insurers to use health status as a factor in setting premiums for people who have had a break in coverage and are trying to get a new individual policy.
Asked to explain Trump's statements, Spicer said Sunday that under the current version of the measure, people with pre-existing conditions who maintain coverage will not be affected. He said waivers would change how states could treat those who don't maintain insurance, and they could find ways to "incentivize people to obtain coverage before they fall ill." He also said states would need to have high-risk pools to get waivers.
House Speaker Paul Ryan's office defended the GOP health bill Monday, saying the measure does protect people with pre-existing conditions.
"States can't opt out without a high-risk pool to take care of them. And waivers never apply to anyone who has been continuously covered," said AshLee Strong, press secretary for Ryan, R-Wis. "We believe there is more than one way to address this problem."
House leaders said last week that the White House was pushing for a vote on the repeal bill to show progress on one of Trump's most significant campaign promises by his 100th day in office, which was Saturday.
But Trump denied that in the CBS interview.
"We really have a good bill," Trump said. "I think they could have voted Friday. I said, just relax. Don't worry about this phony 100-day thing. Just relax. Take it easy. Take your time. Get the good vote and make it perfect."
Medical groups vexed
Doctors, hospitals and other health industry players have opposed Republicans' alternatives to the Patient Protection and Affordable Care Act.
Last week, the American Medical Association said the Republican protections "may be illusory." The American Cancer Society Cancer Action Network expressed concern that the Republican plan could return the U.S. to a "patchwork system" that drives up insurance costs for the sick.
The American Hospital Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association and the American Psychiatric Association all have written congressional leaders warning of negative consequences to patients if the GOP bill becomes law.
Patient advocacy groups like the American Heart Association, the American Diabetes Association, the American Lung Association, the March of Dimes and others are raising similar concerns.
Those concerns are backed by campaign funding. According to the nonpartisan Center for Responsive Politics, the health care sector was the sixth-largest source of political contributions in the 2015-16 election cycle, giving more than $268 million. Health care ranked ahead of lawyers, labor and agribusiness. The industry split its contributions fairly evenly, with a slight edge in gifts to Democrats.
Such groups by and large supported passage of President Barack Obama's law, but they also recognize its problems of complexity and cost and are willing to support changes as long as coverage is maintained or keeps growing.
For the providers, coverage gains and expanded benefits under the Affordable Care Act translate to fewer unpaid bills and better chances of keeping patients healthy. They say such tangible results outweigh the shortcomings of the Obama-era law, which extended coverage to millions of previously uninsured people but remains politically divisive.
"We need to be constantly pushing to get folks to do a bipartisan fix of the [Affordable Care Act]," said Sister Carol Keehan, president and chief executive officer of the Catholic Health Association, representing more than 600 hospitals. "We have to keep blocking and tackling until we get there."
John Cullen, a doctor in Valdez, Alaska, supports efforts by his professional organization -- the American Academy of Family Physicians -- to maintain the Affordable Care Act's coverage gains.
His community of 4,000 people is the terminus of the Trans-Alaska pipeline. While refinery workers tend to have health insurance, fishermen and their families traditionally struggle to afford it. Before what Cullen calls Obamacare, uninsured people would put off medical attention until problems could no longer be ignored. The costs would inevitably be higher and the outcomes often worse.
"If I can see them in the clinic and treat something early, it's really cheap," Cullen said. "If they come in for high blood pressure or cholesterol, that can be treated with medication. But if they're coming in with a heart attack or a stroke, you have to transport them to Anchorage. Transport alone is $27,000 to $70,000."
Information for this article was contributed by Catherine Lucey, Andrew Taylor and Ricardo Alonso-Zaldivar of The Associated Press; by Robert Pear and Kate Zernike of The New York Times; and by Margaret Talev, Jennifer Jacobs, Jennifer Epstein and Anna Edgerton of Bloomberg News.
A Section on 05/02/2017