WASHINGTON -- House Republican leaders plan to hold a vote today on their bill to repeal and replace large portions of the Patient Protection and Affordable Care Act after adding $8 billion to the measure to help cover insurance costs for people with pre-existing conditions.
"We have enough votes," Rep. Kevin McCarthy of California, the House majority leader, said Wednesday night. "It'll pass."
The amendment, drafted by Rep. Fred Upton, R-Mich., secured the support of Upton and Rep. Billy Long, R-Mo. -- two key Republican lawmakers who had come out against the health care legislation earlier this week, warning that it did not do enough to protect the sick.
President Donald Trump endorsed the proposal at a White House meeting with both lawmakers as he pressed for a vote that would at least ensure House approval of the bill, which embodies one of his key campaign promises.
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Today's expected vote carries enormous consequences: for Trump's legislative agenda; for House Speaker Paul Ryan, who has twice failed to get the bill to the House floor; for a U.S. health care system that has faced upheaval for years; and for the patients who rely on it.
Upton predicted that the bill was "likely" to pass in the House.
A Washington Post analysis showed 20 House Republicans either opposed to or leaning against the bill late Wednesday, and 36 more either undecided or unclear on their positions. If no Democrats support the bill, House Republicans can lose no more than 22 GOP votes to pass the bill.
Upton's amendment was not met with resistance by the House Freedom Caucus, a key bloc of conservatives whose opposition to an earlier version of the health care bill led GOP leaders to yank the measure.
"I don't see any defections because of this particular amendment from our previous whip count," said Rep. Mark Meadows, R-N.C., the chairman of the group. Meadows and Upton said they had been in touch.
Ryan, too, was optimistic. "We've got some momentum," he said on a Wisconsin radio station Wednesday morning, after Upton and Long voiced their support for the bill.
Democrats, once confident about another collapse, tried to slow the measure's momentum. The liberal health advocacy group Families USA said another $8 billion would do little to improve so-called high-risk pools that would be set up by state governments to help insure people unable to afford insurance on the open market.
"Trumpcare means heart-stopping premium increases for people with pre-existing conditions, and no Band-Aid amendment will fix it," said House Minority Leader Nancy Pelosi, D-Calif., who, like many in her party, has sought to associate the bill closely with Trump.
Sen. Charles Schumer of New York, the Democratic leader, also criticized the plan.
"The proposed Upton amendment is like administering cough medicine to someone with stage four cancer," he said in a statement. "This Republican amendment leaves Americans with pre-existing conditions as vulnerable as they were before under this bill."
Under Obama's law, insurers must charge healthy and seriously ill customers the same rates.
But the health care measure would let states get federal waivers to allow insurers to charge higher premiums to people with pre-existing illnesses who'd let their coverage lapse. To get the waiver, the state must have a high-risk pool or another mechanism to help such people afford policies.
Opponents have said that would effectively deny such people coverage by letting insurers charge them unaffordable rates. They say high-risk pools have a mixed record because government money financing them often proves inadequate.
How far $8 billion would go to ensure that people with pre-existing medical conditions remain covered is not clear. The Upton amendment doesn't set down any rules on whom states would make eligible for the pool, how much care would be covered or how much individuals could be asked to spend on premiums.
But there is skepticism about whether $1.6 billion a year over five years is enough. According to an analysis from the Kaiser Family Foundation, the temporary high-risk pool created by the Affordable Care Act covered just 100,000 people; the government paid out $2 billion in subsidies to that pool in one year.
Far more people with pre-existing conditions are likely to lose health coverage under the GOP health care plan -- some estimate around 5 million -- and depending on how many states apply for the funds, $1.6 billion could be spread thin.
"For subsidies to cover 68 percent of enrollees' premium costs, as [Affordable Care Act] tax credits do now in the individual market exchanges, the government would have to put up $32.7 billion annually," wrote Emily Gee, a health economist at the progressive Center for American Progress, in an analysis of the Republican plan. "Even after applying that subsidy, high-cost consumers would still owe $10,000 annually toward premiums."
The Upton change is the latest fix Republicans have added to their measure as they've tried to bolster support for it. Last month, they added $15 billion for a program to reimburse insurers who cover patients with pre-existing conditions -- an effort to appease conservatives worried about lowering premiums.
Still, some Republicans remained opposed to the bill. Rep. Carlos Curbelo of Florida, from a Democratic-leaning district, seemed to indicate he was leaning against the American Health Care Act, as the Republican legislation is known, although he said he stood ready to be persuaded by Upton.
And pressure from health care providers, disease advocacy groups and others remains intense. The advocacy arm of the retirees' lobby AARP tweeted that the Upton amendment was an "$8 billion giveaway to insurance companies; won't help majority of those w/preexisting conditions. We remain opposed."
Pelosi said the money would be a small fraction of what is needed.
"It's time for the Republicans to abandon their moral monstrosity and pull this bill," she said.
Republican leaders hope to get the bill through the House today, before lawmakers go home again and face pressure from constituents. Party leaders are facing an onslaught of advocacy groups and Democratic attack ads saying the bill would harm the nation's most vulnerable citizens.
An initial health care bill imploded in March under opposition by conservative and moderate Republicans. The overall bill would cut Medicaid, repeal tax boosts on higher-earning people, eliminate Obama's fines on people who don't buy insurance and give many of them smaller federal subsidies.
Information for this article was contributed by Thomas Kaplan, Robert Pear, Julie Hirschfeld Davis, Jennifer Steinhauer and Margot Sanger-Katz of The New York Times; by Alan Fram, Julie Pace, Ken Thomas, Catherine Lucey, Erica Werner, Matthew Daly and Mary Clare Jalonick of The Associated Press; and by Sean Sullivan, David Weigel, Paige Winfield Cunningham, John Wagner, Kelsey Snell, Ed O'Keefe and Amber Phillips of The Washington Post.
A Section on 05/04/2017
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