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Repeal & Replace Watch

GOP Has No Choice But To Keep Pushing Health Care Rock Up The Hill

Vice President Mike Pence and Office of Management and Budget Director Mick Mulvaney arrive at a meeting of House Republicans on Capitol Hill on Tuesday. (Aaron P. Bernstein/Getty Images)

This week’s effort to resurrect the GOP bill to overhaul the Affordable Care Act has apparently met the same end as the first try in March — not even a vote on the floor of the House. Apparently the roadblock was the same, too. Efforts to gain votes from holdout conservatives repelled moderate Republicans in the House, while efforts to placate moderates kept conservatives from signing on.

So what was the purpose of the new effort, which was led mostly from the White House?

Republican health analysts said party officials had little choice but to keep trying to reach consensus — or at least enough consensus to pass a bill out of the House.

GOP House members, particularly those from conservative areas, “are going to go home and get hammered for not repealing Obamacare,” said Thomas Scully, a health policy official in both Bush administrations.

The latest Kaiser Family Foundation monthly tracking poll suggests that might well be the case. Although three-quarters of the population wants President Donald Trump and his administration to make the health law work, 54 percent of Republicans said it was “a bad thing” that the House GOP bill failed to pass in March, and 58 percent of Republicans said the bill “did not go far enough to end Obamacare.” (Kaiser Health News is an editorially independent project of the foundation.)

Chris Jacobs, a longtime GOP congressional staffer, said there are two imperatives still pushing for some kind of deal. “First, a seven-year commitment by the Republican Party” to repeal and replace the health law, “and second, the administration very clearly wants a win” on some sort of major policy initiative.

But apparently the ideas put forward by the White House to gain more conservative votes without losing moderate ones did not work as the administration hoped.

Conservatives were reportedly pleased early in the week when it appeared states would be allowed to opt out of most of the ACA’s insurance regulations — including rules on what benefits must be covered and whether insurers can charge sicker people higher premiums or deny them coverage.

But moderates complained that would violate promises that the GOP would keep intact protections for people with preexisting health conditions. And the proposal was apparently scaled back.

What remained “was a substantial narrowing in an unproductive way for the proposal,” Michael Needham of the conservative group Heritage Action told reporters on a conference call. Needham called the new version “a nonstarter” for conservatives.

On Thursday, Republicans announced agreement on an amendment to the health bill that would provide $15 billion to help compensate insurers for very high-cost patients.

But at a hastily called meeting of the House Rules Committee, even Chairman Pete Sessions (R-Texas) conceded that the amendment, at least for now, mostly provides a way for members to say they are making progress as they head home to face their constituents.

“What we’re trying to do is lock in ideas so we [Republicans] have an opportunity to go home and amplify,” he said.

Now Congress is poised to leave Washington for a two-week spring recess, from Monday through April 21, without their promised health bill. And what happens when they come back is unclear.

“They put themselves in this box canyon and have no way out of it,” said political scientist Norman Ornstein of the American Enterprise Institute. “I just don’t see a strategy here.”

Scully said it’s more a matter of time. Eventually Republicans will have to come together, because the alternative — leaving the ACA in place — is not acceptable to their voters. “They’ll keep going back and forth until they find something that can pass,” he said.

In addition to their internal differences, the calendar is working against the GOP. When Congress returns from break, it will have only a few days to pass a new temporary spending bill or the government will shut down.

Then there is a desire to turn to a tax overhaul. But in order to do that, Congress must pass a new budget resolution for the coming fiscal year. And as soon as they do, the provisions that would allow an overhaul of the health law to pass the Senate with a simple majority and no Democratic filibuster — which were part of an earlier budget resolution — would disappear.

Jacobs said a big part of the problem is that the GOP is still divided over what should happen with the health law. While the GOP mantra has been “repeal and replace” for several years, he said, “there are differences between the repealers and the replacers. They are two fundamentally distinct approaches separated by the word ‘and.’”

Even if Republicans can’t resolve their differences, they have to keep trying, said Doug Badger, a longtime Senate and White House staffer now at the conservative Galen Institute. “I really don’t think they can get this done,” he said. “But they can’t say they can’t get this done, even though it’s over.”

This story was updated to add details from Thursday’s Rules Committee meeting.

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Insurance The Health Law