Vice President Mike Pence met with the House Freedom Caucus (HFC) on Monday night to pitch potential changes to the American Health Care Act (AHCA) designed to bring conservative holdouts on board with the plan.
Pence's proposal involves waivers to allow states to opt out of the Title 1 regulations of the Affordable Care Act (ACA) as they see fit. The plan would leave the pre-existing conditions portion and the rule allowing individuals to stay on their parents' insurance until the age of 26 intact.
HFC Chairman Rep. Mark Meadows (R-N.C.) has demanded the bill include the repeal of four of Title 1's 12 total mandates. The two regulations Meadows specifically targeted during negotiations last week were the community ratings and Essential Health Benefits portions of the ACA. Leadership was unwilling to bend on those demands.
Pence's offer provides the opportunity for the repeal of those mandates, but it only applies on a state-by-state basis.
Rep. Ken Buck (R-Colo.), one of the few HFC members who supports the bill, wondered if Pence's offer would be enough. “What I hear from a number of [Freedom Caucus members] is that that's the sticking issue: whether they'll consider this enough of a repeal or not,” he told Independent Journal Review.
Meadows told reporters after the meeting he was “encouraged by the idea” but is waiting for the White House to provide text of the altered bill for the group to review.
Not having seen text of the changes, Rep. Dave Brat (R-Va.) was unconvinced. “You know me. I'm either all in or all out,” he said as he left the meeting. When asked if he was all in or all out, Brat didn't hesitate. “I'm all out right now,” he said.
Part of the HFC's unwillingness to commit to backing the changes stems from previous negotiation experiences. Freedom Caucus members are wary of the offer. One member speaking on the condition of anonymity expressed his doubts:
“Too many times they've pushed something, claimed the idea was ours, and then said we were 'moving the goalposts' when we didn't support it.”
“Maybe it's a good proposal, maybe it's not,” the member continued. “We want to see the text.”
With the White House rushing to reach some agreement before Congress takes its Easter recess, the text of the new bill is expected to be ready Tuesday.
Buck wanted the bill to pass in the House before the break. “I was hoping for a vote this week, but everybody thought I had lost my mind,” he told IJR. “I'm hoping that as soon as we come back, it'll be ready to go.”
The White House and Republican leadership have been walking a thin line trying to keep moderate members and conservative members happy with the legislation — their inability to do so the last time they tried to pass the AHCA was, in part, what led to its failure.
Hoping to alleviate conflict between the two groups, Pence also met with members of the moderate so-called Tuesday Group to run the potential changes by them on Monday afternoon.
Rep. Chris Collins (R-N.Y.), a Tuesday Group member, emerged from the meeting more optimistic about the bill's chances than he was before. He believes the moderates who have previously expressed concerns may be satisfied with the safeguards the White House laid out during the meeting.
“The states would be allowed to make a waiver on the Title 1 issues,” Collins said, but states would be required to provide evidence the changes would drive costs down and improve coverage.
Whether or not the bill will strike a balance keeping moderates and conservatives alike happy remains to be seen.
The clock is ticking, though, and lawmakers are feeling the pressure to come to an agreement before going home on Friday.
White House Chief of Staff Reince Priebus downplayed the undoubtedly high stakes of the meeting as he left.
“We're just talking,” he said.