The fate of the bill to repeal and replace Obamacare remains in flux as House Republicans scramble to get enough votes for it to pass through a divided Republican Party before lawmakers head home for a week-long recess.
Negotiations between Rep. Mark Meadows, R-N.C., chairman of the hardline House Freedom Caucus, and Rep. Tom MacArthur, R-N.J., who heads the moderate Tuesday Group, produced an amendment last week that made the legislation more conservative. The amendment allowed states to apply to waive regulations that require insurance companies provide specific coverage, such as as maternity and mental health care.
The move brought on board more than two dozen conservatives who were previously against the legislation and were critical in sinking the first version of the bill back in March. But the new amendment also bled the support of moderates who raised concerns over a lack of cost protections for people with pre-existing conditions.
“The way that it is structured right now, there is an amendment that in essence, is part of this bill that now allows the governors to waive pre-existing illnesses as part of essential benefits. The Freedom Caucus insisted on this position,” Rep. Fred Upton, R-Mich., told local radio station WHTC on Tuesday. “I’m not at all comfortable with removing that protection. I’ve supported the practice of not allowing pre-existing illnesses to be protected against from the very get-go. This amendment torpedoes that and I told leadership I cannot support this bill with this provision in it.”
“There are a good number of us that have raised red flags and concerns and it’s not going to get my yes vote the way that it is,” Upton continued. Upton is the former chairman of the House Energy and Commerce Committee, which has played an instrumental role in drafting the legislation.
By multiple news outlets’ counts, roughly 20 lawmakers said they’d vote “no” on the legislation as of Tuesday afternoon and about two dozen others remained undecided. Because no Democrats are expected to vote for the bill, Republicans can only lose about 20 votes and still pass the bill
"I’ve always stated that one of the few good things about Obamacare was pre-existing conditions," Rep. Billy Long, R-Mo., also a member of Energy and Commerce, told USA TODAY on Monday. The new bill "strips away any guarantee that people with pre-existing conditions could be covered at an affordable rate."
Rep. Ryan Costello, R-Pa., nodded when reporters at the Capitol asked Tuesday whether he remained a “no” on the legislation and said there was no indication from leadership on how close they were or when there might be a vote.
Rep. Peter King, R-N.Y., who was previously for the legislation, said he was now undecided because details of the bill remained up in the air.
“I tend to vote 'yes,' but again, the language is not really finalized,” King said. When a reporter pointed out that Republican leadership had been saying the current draft of the bill was the final version, King responded: “If they don’t have the votes then they’re going to have to make changes.”
The amendment requires that insurance companies cover people with pre-existing conditions but does not prohibit companies from charging those people more. States can waive cost protections for people with existing health conditions if they have set up a risk-sharing program, which is intended to help lower their costs, but the system has proven costly and has had mixed results in the past.
Trump told Bloomberg on Monday that the health care bill was still being tweaked and will end up being “every bit as good on pre-existing conditions as Obamacare.” But House leadership has pushed lawmakers to vote on the current version of the bill.
“I don’t think he meant that in the way that it came out. I mean he just said ‘look we’re going to make it real good,' I mean he was just saying you know we’re going to do a good bill,” Rep. Dave Brat, R-Va., told reporters Tuesday.
Brat, who is a member of the Freedom Caucus, was against the first version of the bill but is now supportive of the amended version. He said there was no need to start renegotiating pre-existing conditions because “you can’t make it much better.”
Brat’s Freedom Caucus colleague Rep. Mo Brooks, R-Ala., told CNN on Monday that higher costs were acceptable for people with pre-existing conditions so they could help cover costs for people who were healthy.
Meanwhile, Republican leadership scrambled to tamp down controversy regarding the bill.
“We've been making important progress on this bill,” Majority Whip Steve Scalise, R-La., told reporters Tuesday.
"Our bill protects people with pre-existing conditions.”
House Speaker Paul Ryan, R-Wis., said that the president’s comments were not undermining the health care effort.
"We're making very good progress with our members, and the president has been instrumental in that,” Ryan said.
Later Tuesday, his office issued a release on controversial parts of the amendment, including pre-existing conditions.
“The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition. Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if that state has chosen to take care of the people through other risk-sharing or reinsurance mechanisms,” his office said.
No vote has been scheduled, and Ryan has repeatedly said he won't schedule a vote until he knows the bill will pass. But there’s urgency to get something done over the next few days. Lawmakers are set to go back home at the end of this week for a weeklong work period in their districts, and many are worried about facing constituents for another recess without completing the repeal. Lawmakers are also pressed to get health care legislation done before they can move on to tax reform.