The White House’s latest last-ditch effort to save the GOP’s Obamacare replacement bill hit a brick wall Tuesday night, as conservative and moderate Republicans met and realized they had two very different understanding of the changes sought by top Trump officials.
Conservatives in the House Freedom Caucus say Vice President Mike Pence, chief of staff Reince Priebus and budget director Mick Mulvaney sought to win their votes by offering a repeal of major Obamacare regulations during a Monday night meeting. But moderates who met with the same Trump officials hours before were told the changes wouldn’t be as far-reaching.
The discrepancy in what was or was not promised became increasingly apparent throughout the day Tuesday, according to multiple sources across the spectrum of the House Republican Conference.
A late-night huddle with Pence and the leaders of all the GOP caucuses in the basement of the Capitol failed to clarify the issue, leaving Hill insiders speculating whether the White House offered two different potential deals — or lawmakers selectively heard what they wanted.
Republicans plan to meet again Wednesday. But it is unclear where they go from here. It’s also all but certain that the House won’t be voting on a bill to replace the 2010 health care law before the two-week Easter recess.
“There were no agreements tonight in principle, and certainly no agreements in terms of a foundation,” Freedom Caucus Chairman Mark Meadows said Tuesday night while exiting the meeting. The North Carolina Republican said members had a “good discussion,” but he acknowledged that “there’s a whole lot of things we have to work out in terms of differences.”
The crux of the issue stems from different interpretations about what White House officials — and House Republicans, for that matter — mean when they say they want to retain Obamacare’s protections for sick individuals or those with pre-existing conditions.
Everyone, from President Donald Trump to conservatives to moderate members of the GOP conference, say they want to keep these protections. But they disagree over which Obamacare regulations comprise the fundamentals of that safeguard.
Case in point: Pence told hard-line Freedom Caucus members Monday night that changes to the bill would allow governors to opt out of Obamacare’s “community rating” provision, which prohibits insurers from charging higher premiums to people who are sick, are older or based on their gender. Without it, insurers could charge more to people with cancer or other medical conditions, though supporters say it would drive down premiums for healthy people.
Meadows said they were told governors would be allowed to opt out for “all community ratings with the exception of gender.”
But moderate GOP members who met with Pence the same day say they were under the impression that governors would only receive “community rating” flexibility based on a person’s age — not their illness or other factors. They argue the “community rating” provision goes hand-in-hand with Obamacare regulations that bar insurance companies from rejecting people with pre-existing conditions — and that without it, the pre-existing conditions protections are meaningless because insurance companies could price sick people out of the market by charging them exorbitant premiums.
That’s not the only discrepancy. Some Freedom Caucus members say the White House also floated the idea of letting governors opt out of the law’s “guarantee issue,” which bars insurance companies from turning away sick people. The idea, Meadows said, would be to send such individuals to state-run risk pools where they can get insurance partially subsidized from a $115 billion “stability fund” that would go to the states to help keep premiums down.
“This high-risk pool… is a 100 percent guarantee,” Meadows said late Tuesday. “Guarantee issue happens automatically with this back stop. You guarantee coverage 100 percent of the time. With that, the guarantee issue from an individual carriers point of view becomes a moot point.”
But that’s not at all what centrists said they heard from Pence. Multiple sources said that Energy and Commerce Chairman Greg Walden, who met with Pence, other White House officials and centrist members of the conference Monday, had started drafting legislative text that would only allow the opt-out for age, not everything else. And it would keep the guarantee issue in place, which other Republicans in the conference view as essential in their replacement plan.
Republicans must have realized they had a potential problem; they did not present any text to the broader group Tuesday night. Drafting continues, sources said, though it’s far from clear where it will go next.
“Energy and Commerce has and will continue to provide technical drafting guidance for legislative proposals at the request of the White House and House Leadership,” a panel aide said in a statement. “The Committee will continue to work with all parties as discussions continue on how to best come to a consensus.”
Jennifer Haberkorn and Kyle Cheney contributed to this story.