The House GOP Health Care Bill Is Very Much Alive

And it could be disastrous for the sick.

WASHINGTON ― House Republicans still don’t have a deal to revive their health care bill, but the White House is laying the groundwork for negotiations to move quickly, meeting individually Monday with moderates and conservatives to discuss a possible agreement.

That agreement, which is still far from a reality, would hinge on Republicans accepting changes to their health care bill that would violate a key promise from President Donald Trump, namely that insurers would have to offer plans to people with pre-existing conditions.

While those regulations would still technically exist, the idea is that the House bill would now allow states to opt out of “community rating” regulations, which compel insurers to offer plans at the same rate for sick people. Ditching those protections would let insurers charge exorbitant rates for people with pre-existing conditions while also offering plans that don’t offer key services, like maternity care, hospitalization or lab services. Conservatives believe those people would then go into so-called high-risk pools for coverage, but the effect would still likely lead to people who need health care the most paying the most ― or not being able to afford coverage at all.

On Monday, for roughly an hour and a half, the White House hosted a meeting with House Energy and Commerce Chairman Greg Walden (R-Ore.) and seven moderate Republicans from the Tuesday Group who had already supported the health care legislation ― Chris Collins (N.Y.), Rodney Davis (Ill.), Adam Kinzinger (Ill.), Tom MacArthur (N.J.), Martha McSally (Ariz.), Bruce Poliquin (Me.) and Pat Tiberi (Ohio) ― to make sure potential changes wouldn’t lose their votes.

Those lawmakers met with Vice President Mike Pence, chief of staff Reince Priebus, Office of Management and Budget Director Mick Mulvaney and Andrew Bremberg, the director of White House domestic policy.

Collins, who said last week that he didn’t think Republicans could pass a health care bill until 2019, reported Monday that he had newfound optimism.

“I am going to hope,” he said.

Later in the evening, the same group of White House leaders joined the Freedom Caucus for 45 minutes to discuss the tentative changes. And while Freedom Caucus Chairman Mark Meadows (R-N.C.) said conservatives were willing to look at legislative text, which they expect in the next 24 hours, they need to see the details of a plan before they can agree to anything.

“There is no deal in principle,” Meadows said. “There is a solid idea that was offered.”

Again, the “solid idea” is allowing states to waive a number of provisions of the Affordable Care Act as well as the so-called essential health benefits, a set of 10 basic services that insurers are mandated to provide.

Meadows said Monday night that the pre-existing conditions protections would remain in the new form of the health care bill, but when pressed on whether gutting the community rating provisions would allow insurers to charge people with pre-existing conditions more, he acknowledged that some sick people may be picking up the slack so that premiums of the healthy would go down.

“The fundamental idea is that marginally sick people would pay the risk associated with their coverage,” Meadows said. “Those that have premiums that would be driven up because of catastrophic illness or long-term illness, we’ve been dealing with that for a long time with high-risk pools.”

“There is no deal in principle. There is a solid idea that was offered.”

- Rep. Mark Meadows (R-N.C.), chairman of the conservative Freedom Caucus

Conservatives are open to the idea of sending more money to the high-risk pools so they could serve as a “backstop” for people who couldn’t get decent coverage because of pre-existing conditions. But a majority of states ran high-risk pools before the Affordable Care Act, and the pools were notorious for high premiums and deductibles, along with annual or lifetime limits on coverage. In other words, the pools lacked the kind of coverage and protections that people with medical problems need ― and they frequently wouldn’t cover pre-existing conditions for six to 12 months.

Those misgivings notwithstanding, adding more money to the high-risk pools is a priority for moderates, and the tentative deal would further outline how $115 billion in funding that was already added to the bill would go to those pools.

But it’s an open question whether the votes would be there for this yet-to-be-written version of the bill. Republicans have no timeline on a vote, though the White House seems to prefer passing the bill as soon as possible, potentially even this week so that Republicans don’t have a chance to go home for a scheduled recess next week and be dissuaded by constituents.

Republicans, however, still have major issues to work out.

Collins reported that there was a lot of discussion in the moderates’ meeting with the White House about the community rating issue, and it’s “maybe, maybe not” whether moderates could allow states to waive those Affordable Care Act provisions.

“I would say you put that in the ‘To be continued,’” he said.

To get to a deal with the Freedom Caucus, conservatives would likely need states to be able to waive those community rating protections, which may be difficult for moderates to swallow. Additionally, there are already more than a dozen moderate Republicans who have announced opposition to the bill, though they could still change their mind.

But the other dynamic is that there are some conservatives who, even with a deal, probably won’t support the legislation. Asked about those holdouts on Monday night, Meadows acknowledged the Freedom Caucus wouldn’t vote as a bloc, but he also said he thought there’d be less than six members in the group who wouldn’t support a deal.

Still, for Meadows, another real question is whether these changes would survive a “Byrd rule” challenge in the Senate, which subjects policy changes that do not significantly alter the cost of a reconciliation bill to 60 votes.

“There’s always concern about anything passing the Byrd rule,” Meadows said. But he added that the White House and lawmakers were working with the Senate parliamentarian to produce text that would “pass muster” and not be subject to 60 votes.

But while a deal seemed to be in the offing, the bad blood among the Freedom Caucus, moderates and the White House was still a potential problem. Some Freedom Caucus members privately expressed concern Monday night to The Huffington Post that the administration could be playing a game to once again pin blame on conservatives and accuse them of moving the goal post.

The Freedom Caucus saw how Trump and his administration pinned blame on its group, and key members of the caucus worry that the White House first negotiating with moderates, seeming to reach a deal, could be a setup to further drive a wedge in their group if the legislative text does less than conservatives had hoped.

When Meadows was asked about the potential for conservatives to again take the blame, he made it clear this was a White House offer, not one from the Freedom Caucus, so if it turned down the deal, it wouldn’t be the conservatives pulling a bait-and-switch.

“The goal post has been moved, as you know, but it’s been moved closer to the kicking team,” Meadows said. “So hopefully they can make a field goal from five yards out.”

Jonathan Cohn contributed to this report.

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