House Freedom Caucus endorses latest health plan

WASHINGTON -- An influential group of House conservatives threw its support behind a new Republican plan to revise the Patient Protection and Affordable Care Act, shifting political pressure onto GOP moderates to determine the effort's fate.

The House Freedom Caucus said the amendment negotiated by its chairman, Rep. Mark Meadows, R-N.C., along with moderate Rep. Tom MacArthur, R-N.J., would drive down health care costs under the law implemented by former President Barack Obama.

The amendment would allow states to opt out of certain insurance provisions, including the requirement that health plans cover essential medical benefits and the ban on charging customers higher premiums if they have pre-existing conditions.

"While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health-care costs," the Freedom Caucus said Wednesday in a statement.

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The decision came as three conservative advocacy groups -- the Club for Growth, FreedomWorks and Heritage Action for America -- also declared support for the plan, adding to its momentum.

"To be clear, this is not full repeal," Heritage Action chief executive Mike Needham said in a statement. "The amendment does, however, represent important progress in what has been a disastrous process."

Attention now shifts to the moderate Tuesday Group, some of whose members will need to support the amendment for it to pass.

Republican leadership can afford to lose only about 20 votes if most of the Freedom Caucus backs the measure. As of Wednesday afternoon, about 30 Republicans who are not members of the Freedom Caucus were either opposed to the plan or were undecided.

Rep. Charlie Dent, R-Pa., co-chairman of the Tuesday Group, said most of the moderates who opposed the original GOP bill were not privy to MacArthur's negotiation and would vote "no" on his amendment.

He accused the Freedom Caucus, which thwarted Republicans' first attempt to overhaul the health care system, of trying to shirk responsibility for the effort. "It's an exercise in blame-shifting," Dent said.

The Club for Growth issued a thinly veiled threat against Republican moderates who might vote against the amendment if it comes to the floor.

In an interview Wednesday, President David McIntosh said centrist Republicans skeptical of the bill are "being smoked out" now that conservative organizations and the Freedom Caucus have endorsed it. He said advocates of the bill are "still gathering the votes."

Even if the bill does pass the House, it faces skeptical Republicans in the Senate.

Several Senate Republicans from large states that accepted the Affordable Care Act's Medicaid expansion previously opposed the House legislation for cutting that portion of the law, a move that would leave millions of people without health insurance.

Matt House, a spokesman for Senate Minority Leader Charles Schumer, D-N.Y., said the GOP's latest plan would run afoul of Senate rules governing the reconciliation process, which protects legislation from filibuster.

But two GOP Senate aides familiar with the negotiations said they did not share the view that Schumer's team expressed.

"The MacArthur-Meadows language has been reviewed in the Senate and we believe it would not endanger the privilege of the House bill should it be included," said one of the GOP Senate aides, who spoke on the condition of anonymity.

But the aide added a note of caution, saying that "final determinations" can't be made until any new bill receives a score from the nonpartisan Congressional Budget Office.

The revival of the Republican health care effort is welcome news for the White House, particularly after last month's defeat. But while Trump is eager to achieve as much as possible this week before Saturday marks the 100th day of his presidency, some in his party were wary of setting a deadline before reluctant members were ready to endorse the bill.

"We'll vote on it when we get the votes," House Speaker Paul Ryan, R-Wis., said at a news conference Wednesday.

"What we see is progress being made, showing that we're moving and getting on the same page," he said.

Momentum is building for the plan despite the revelation that, under its current language, members of Congress would be all but guaranteed to maintain health benefits that other Americans stand to lose.

That is because lawmakers obtain health insurance through a marketplace operated by the District of Columbia, which is unlikely to seek a waiver to opt out of the law's coverage requirements. That means lawmakers' plans would be left intact, even if insurers in their home states were allowed to cut benefits.

Meadows assured lawmakers the issue would be addressed.

"If you look at the text, it actually penalizes members of Congress and people in D.C.," he said. "But we understand the optics, and we're working on that to make sure that it gets fixed."

House Minority Leader Nancy Pelosi, D-Calif., said the amendment proposal makes the Republicans' plan "even more cruel and costly for America's families."

"Families will be slammed with brutal premium increases," she said. "Many would lose access to affordable health coverage entirely, on top of the 24 million hardworking Americans who would already lose insurance under the original Trumpcare language."

Mulvaney, Pelosi Clash

Also on Wednesday, the White House and congressional Democrats defused a tense standoff over payments for the working poor under the health care law, keeping a government spending bill on track just days ahead of a shutdown deadline.

Trump backed away from a threat to immediately withhold payments that help people with modest incomes with out-of-pocket medical expenses under the Affordable Care Act.

The dispute with Democrats, in particular Pelosi, threatened to hold up the $1 trillion-plus spending bill. A temporary funding bill expires Friday at midnight, and GOP leaders are trying to pass another short-term spending bill to prevent a government shutdown this weekend.

White House budget director Mick Mulvaney sparred with Pelosi on the health-payments issue over the phone Tuesday evening and in a series of public statements Wednesday. Ultimately, Pelosi turned to White House Chief of Staff Reince Priebus to obtain assurances that the administration would continue to provide the payments.

The weekslong dispute over the health care issue had snagged the talks, which have progressed steadily for weeks and gained momentum earlier this week after Trump dropped demands for immediate money to build his long-promised border wall.

"Our major concerns in these negotiations have been about funding for the wall and uncertainty about the ... payments crucial to the stability of the marketplaces under the Affordable Care Act," Pelosi said in a statement. "We've now made progress on both of these fronts."

Partisan disagreements over the environment, abortion and GOP efforts to reverse Obama-era financial regulations continue to stand as obstacles in the negotiations, but both the administration and many congressional Democrats were hopeful of sealing an agreement relatively soon.

Information for this article was contributed by Elise Viebeck, David Weigel, Sean Sullivan, Paul Kane, Kelsey Snell and Jenna Portnoy of The Washington Post; and by Andrew Taylor of The Associated Press.

A Section on 04/27/2017

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