House conservatives and the White House are mulling a potential agreement to revive the GOP Obamacare replacement bill that was pulled from the House floor just over a week ago, POLITICO has learned.
The House Freedom Caucus, the group of three-dozen conservatives that helped bring down the bill, has been in talks with Trump administration officials about changes to the legislation that might get them to “yes.” One option seriously being considered, multiple GOP sources said, includes allowing governors to opt out of some Obamacare regulations on the insurance industry.
The developments could mean that Speaker Paul Ryan’s bill might not be dead after all — or at least indicate that continued discussions are going on behind the scenes.
Sources stressed that the details are still being finalized, and it’s far from certain that such a change would act as a silver bullet to salvage the much-maligned bill. It is unclear whether such an idea would win over enough conservatives while also keeping centrist Republicans on board.
Indeed, Freedom Caucus Chairman Rep. Mark Meadows said Monday night he was not certain yet whether any of the policies being discussed will change his group’s concerns with the bill: “Any proposal that has merits to address in a meaningful way insurance premiums we’re willing to consider. But there’s no deal, no offer, and there is certainly nothing that would indicate that a deal was imminent.”
The White House, however, ran traps on the potential changes with moderates Monday afternoon, summoning more than half a dozen Republicans in the moderate Tuesday Group to discuss the tweaks. Vice President Mike Pence, chief of staff Reince Priebus and Trump budget director Mick Mulvaney huddled with Energy and Commerce Chairman Greg Walden (R-Ore.), Tuesday Group co-chairman Tom MacArthur (R.-N.J.) and a handful of their moderate-minded colleagues. One member who attended, Trump ally Rep. Chris Collins (R-N.Y.), said the group gave the administration the green light to forge ahead if they think they can win the Freedom Caucus.
“If they couldn’t get it passed those of us who are ‘yes’ in the Tuesday Day group, then it would be clear then that it didn’t have any legs,” Collins said. “But we said, ‘No — you definitely have some legs.”
Pence will try to woo conservatives on the changes during a Freedom Caucus meeting Monday night. Sources cautioned that while everyone wants to vote on a deal quickly, lawmakers are far from scheduling a floor vote.
The renewed talks come as President Donald Trump cranks up the heat on conservatives for tanking the GOP replacement plan. The president tweeted last Thursday and Friday that the Freedom Caucus had become a roadblock to his agenda, and he encouraged Republicans to “fight” them in 2018, hinting at primary challenges.
Trump also specifically called out Freedom Caucus Chairman Mark Meadows (R-N.C.), Vice Chairman Jim Jordan (R-Ohio) and group member Raul Labrador (R-Idaho), turning millions of his followers on the group’s leaders. Jordan defended the group’s blockade Sunday, arguing that the bill would not significantly lowers premiums or fully repeal President Barack Obama’s health care law.
“Tweets and statements and blame don’t change facts, and the facts remain the same: When you look at the document, when you look at the legislation, it doesn’t repeal Obamacare,” Jordan said on CNN’s “State of the Union.” “Even people who support it say it… doesn’t bring down premiums.”
Behind the scenes, however, Trump officials — including the president himself— have been reaching out to conservatives to see if there’s a way to garner their support. Over a round of golf this weekend, Trump sought to woo firebrand Sen. Rand Paul, a close Freedom Caucus ally who helped rally the group to oppose the bill.
Meanwhile, during a Ryan donor retreat late last week, White House legislative liaison Marc Short told attendees the White House was working hard behind the scenes to come up with a deal. Sources familiar with the ongoing talks say even outside conservative groups that opposed the replacement legislation, including Heritage Action and Americans for Prosperity, are showing a willingness to work with them.
One administration source didn’t think a deal was imminent but said the White House is pushing for one “very quick.”
“This is a level of urgency I haven’t seen out of them,” the source said.
Rand (R-Ky.) on Monday floated another potential change to reporters: a proposal to leave some Obamacare subsidies intact, albeit scaled back, instead of replacing them for tax credits. Such a modification, he argued, would “placate the people who want” to continue providing government assistance for health care — without asking conservatives to support tax credits they’ve deemed a “new entitlement program.”
Paul said he discussed his proposal with Trump over golf and has brought the idea to the Freedom Caucus and the White House. It did not appear, however, that the White House or GOP leaders in Congress were inclined to run with the idea.
“They’re banging a square peg into a round hole right now,” Paul said of the Trump administration. “They either keep banging it hard enough that they get the votes for it, as is, or we take a new approach.”
In the closing days of negotiations, before Ryan pulled the bill amid a lack of support, Freedom Caucus conservatives said they needed a repeal of so-called Title One regulations in order to win their support. Those include popular provisions such as barring insurance providers from discriminating against people with pre-conditions and allowing adults under age 26 to keep coverage under their parents’ insurance.
Conservative sources have suggested, however, that they’re fine with retaining those insurance regulations if they can axe other Obamacare regulations from Title One. A source involved in the conversations said the parties are still discussing which regulations governors would be allowed to sidestep but said the talks could shape the “contours of a deal.” No text has been written.
“There does seem like there is a willingness [from the White House] to get at the regulations conservatives have been talking about,” the person said.
Meadows said he’s had “cursory” conversations with administration officials “within the last 72 hours” about some ideas that could revive health care talks. But he said he wasn’t expecting an offer from the administration to emerge Monday.
“We’ve seen nothing,” he said. “We have been presented nothing.”
Under the floated changes, governors wanting waivers for Obamacare regulations would have to show that exemptions would improve coverage and lower costs, Collins said.
Conservatives are particularly interested in state flexibility on Obamacare’s “community rating” provision, which requires insurance companies to charge the same premium price to everyone — regardless of how sick or old they are. Without it, insurers could charge more to people with cancer or a history of smoking or for elderly people. Eliminating the requirement would likely drive down premiums for healthy people but would increase them for sicker people.
That’s different than Obamacare’s pre-existing condition requirement, which bans insurers from denying customers because of their old medical conditions. The community rating requirement simply bans them from charging customers more.
It’s unclear how moderates will react to those changes. That’s why the White House called them in to discuss the matter Monday, assuring them that several other changes would likely be made to keep their support.
The White House is looking at changes to the $115 billion “stability fund,” which in the original bill allowed governors flexibility in how they divvy up that cash. Under the emerging agreement, states would be required to use a large chunk of that money to help finance “risk-pools,” where sicker individuals purchase insurance. Republicans working on the matter said it would bring down premiums for those individuals.
The source also said the White House was considering retaining Obamacare’s essential health benefit requirements, which mandates basic coverage like mental health and maternity leave, but allowing governors to opt out of them.
Repealing essential health benefits has been a central requirement to win Freedom Caucus support.
Kyle Cheney and Elana Schor contributed to this article.
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