By Kristina Peterson, Siobhan Hughes and Natalie Andrews
WASHINGTON -- The GOP plan to replace the Affordable Care Act,
backed by President Donald Trump and House Speaker Paul Ryan,
remained in jeopardy Wednesday after a day of intense negotiations
among Republicans, but the prospect of a last-minute deal showed
signs of bringing many of the holdouts on board.
Ahead of a planned vote by the House on Thursday, Mr. Trump and
Vice President Mike Pence, as well as other senior administration
officials, huddled with lawmakers through the day on proposed
changes to the bill, aiming in particular to win support from a
bloc of conservatives.
But it wasn't until Wednesday night that the outlines of a deal
emerged that had potential to secure passage of one of the party's
central policy goals, replacing the law known as Obamacare.
GOP leaders were exploring whether they could repeal the ACA's
requirement that insurance policies cover 10 specific benefit
categories, known as essential health benefits. Those include
maternity care, certain pediatric and mental-health services and
preventive health services. Some Republicans believe the
requirement has driven up premiums, while Democrats say it ensures
that plans truly cover needed services.
"We're encouraged tonight at the real willingness of not only
the White House but our leadership to make this bill better," said
Rep. Mark Meadows (R., N.C.), who leads a group of 30 to 40
conservatives called the House Freedom Caucus, many of whom have
said the bill doesn't go far enough in wiping away the 2010 health
law championed by Democrats.
It was the most optimistic assessment from Mr. Meadows in recent
days. But he cautioned: "We're not there yet."
Mr. Trump called Mr. Meadows on Wednesday night during a meeting
of the caucus to discuss the latest proposed changes, aiming to
urge the process along. "We're very optimistic that if we work
around the clock between now and noon tomorrow that we're going to
be able to hopefully find some common ground," Mr. Meadows
said.
Other conservative lawmakers also left the caucus meeting
optimistic.
"Most good things happen toward the end of the discussion," said
Rep. Trent Franks (R., Ariz.).
House leaders haven't yet decided whether to make the change to
the bill, and thee proposal was still under negotiation. Its
reception among more centrist Republicans, some of whom are also
wary of the bill, remained unclear, and the measure threatened to
significantly complicate the bill's passage in the Senate.
Until Wednesday night, House GOP leaders had warned
conservatives that eliminating the coverage requirements in the
House bill would risk stripping it of its special procedural status
when it goes to the Senate. Republicans are using a procedural
shortcut that would enable them to pass the bill in the Senate with
only GOP votes, requiring a simple majority, rather than the 60
votes that most legislation needs in the Senate. Republicans hold
52 seats in the chamber.
"What we just don't want to do is put in a 'fatal provision,' "
Mr. Ryan had said Wednesday morning on a Wisconsin radio show.
But by the evening, House GOP leaders said they received new
advice from Senate Republicans: While the change might not survive
in the Senate, it wouldn't enable Democrats to block the whole
bill, a GOP leadership aide said.
About 30 House Republicans had remained opposed to the bill
earlier in the day, a survey of House GOP members by The Wall
Street Journal found. GOP leaders can lose no more than 22
Republican votes, since no Democrats are expected to support the
bill.
The bill would dismantle much of the ACA's taxes and subsidies,
and replace them with tax credits largely tied to age, aimed at
helping people afford insurance if they don't get it through
employers.
If insurers were no longer required to offer the set of mandated
benefits in their plans, costs likely would rise for sicker and
older people, who are more likely to want generous policies with
comprehensive coverage. Younger, healthier consumers would be more
likely to purchase the new, less-comprehensive health plans.
Senate Democrats said Wednesday night that Republicans wouldn't
be able to retain the provision eliminating those benefits if the
bill made it to the Senate.
"It will require 60 votes to repeal these protections, and the
votes just aren't there in the Senate," said Matt House, spokesman
for Senate Minority Leader Chuck Schumer (D., N.Y.). "It speaks
volumes about the Republican Party that they need to try to make
this bill worse for the American people in order to buy off the
Freedom Caucus."
Also unclear was how the new proposal would affect the votes of
centrist Republicans in the House, some of whom want the bill to
offer more generous help to older and low-income people to help
them afford insurance.
House Republicans voted nearly 90 times to repeal parts of
President Barack Obama's 2010 health-care law while he was in
office. But with a Republican in the White House and the prospect
of a repeal becoming law, the party struggled to bridge
longstanding differences over the government's role in health
care.
Failure to pass the health plan would be "a big blow to the
president, who is 100% behind this bill," said Rep. Tom Cole (R.,
Okla.). "It would obviously be a terrific setback for our
leadership, and it's a big blow to Republican confidence." Defeat
for the bill would also damage the prestige of Mr. Ryan, one of its
main promoters.
GOP aides said there was no strategy in place for what would
happen if the bill fails on the House floor Thursday.
"There is no Plan B," White House press secretary Sean Spicer
said Wednesday. "There's a Plan A and a Plan A. We're going to get
this done."
However, some Conservative interest groups remained strongly
opposed to GOP bill. Organizations backed by billionaire
industrialists Charles and David Koch said late Wednesday that they
would spend millions of dollars to defeat the health-care bill, the
Associated Press reported.
--Stephanie Armour and Louise Radnofsky contributed to this
article.
Write to Kristina Peterson at kristina.peterson@wsj.com, Siobhan
Hughes at siobhan.hughes@wsj.com and Natalie Andrews at
Natalie.Andrews@wsj.com
(END) Dow Jones Newswires
March 22, 2017 22:57 ET (02:57 GMT)
Copyright (c) 2017 Dow Jones & Company, Inc.