House Speaker Paul Ryan (R-WI) Meets With Leading Conservatives
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After two weeks of continued behind-the-scenes negotiations on the GOP leadership's American Health Care Act (AHCA), Republicans are pinning their hopes for the bill's passage prior to President Donald Trump's 100th day in office on a proposed amendment originating from a leading moderate member, Rep. Tom MacArthur (R-N.J.).

The Huffington Post first reported the details of MacArthur's proposal on Wednesday night, and Politico followed up with a copy of the rumored white paper that describes its changes Thursday morning.

The amendment, which presumably came about through ongoing discussions between House Freedom Caucus (HFC) Chair Mark Meadows (R-N.C.) and MacArthur, a co-chair of the moderate Tuesday Group, is similar to a concept Vice President Mike Pence proposed three weeks ago.

The MacArthur amendment would enable states to pursue the repeal of certain Title 1 Affordable Care Act (ACA) mandates via “Limited Waivers.” Those waivers, according to the document, could be applied to:

  • Essential Health Benefits.
  • Community ratings, with the exceptions of gender and age protections.
  • Health Status, as long as states set up high risk pools or participate in a federal high risk pool.

The amendment seeks to sway moderate Republican members who have expressed concerns about the idea by restoring the ACA's Essential Health Benefits to a federal standard — a provision the GOP leadership delegated to the states in a last-minute attempt to bring the HFC's holdouts on board with the bill during the first round of AHCA negotiations.

MacArthur's plan would also require states to provide evidence that waiving community ratings and Essential Health Benefits would “reduce premium costs, increase the number of persons with health care coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions.”

Those assurances for moderates don't necessarily address their doubts, though.

The amendment still allows states to scrap the ACA's community ratings, a rule preventing insurers from charging individuals with pre-existing conditions higher prices for health insurance.

It also neglects to appeal to moderates on Medicaid. It overlooks their problems with the AHCA's current conservative plan, which institutes a block grant option for state Medicaid funding along with work requirements for able-bodied adults on the program and a 2018 rollback of Obamacare's Medicaid expansion.

Before Congress took its April recess, Chief Deputy Whip Patrick McHenry (R-N.C.) told reporters the potential changes — now included in the proposed MacArthur amendment — “have diminished votes, not increased it.”

With those changes appearing more likely to be added to the health care bill, moderate members may be compelled to push back. Adding to the uncertainty, members told Independent Journal Review they still haven't seen text of the amended bill. That's a point of concern, especially for the conservative hardliners of the House Freedom Caucus.

Sticklers for details, the group of about three dozen lawmakers — who, for the most part, opposed the Republican leadership's AHCA when it was introduced two months ago — won't make a decision without having reviewed the text.

Nonetheless, signaling a renewed push on AHCA, the Republican leadership is expected to pitch the new plan to members during a GOP conference call on Saturday.

If House Speaker Paul Ryan (R-Wis.) hopes to get the health care bill out of the House and on to the Senate by next week, he will face an uphill battle. Not only will he need to convince his colleagues to support a vastly unpopular bill in just a few days' time, but he will also have to get the party to rally behind a spending bill to keep the government up and running before a funding deadline on Friday.

Still, Meadows believes the conference will pass the health care bill before April 29. Speaking on a local radio show during the recess, Meadows promised health care will “be done in this first 100 days.”

Others are less convinced the bill can get to 216 votes so soon.

A Freedom Caucus member expressed his doubts over Meadows' hopes for AHCA negotiations when speaking with IJR on Thursday morning. The lawmaker said Meadows' tendency toward “undue optimism” had brought trouble for the HFC in the past and could do so again.

While the White House continues pressuring lawmakers to hold a vote next week, the Republican leadership is markedly less certain about committing to such an ambitious timeline.

But if a vote is called, members believe the GOP leadership will make sure the bill will have the support for it to actually pass this time.

“I don't know that there's going to be a vote,” Meadows told IJR before the break, “but if there's a vote called, it'll pass.”

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