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April 7, 2017

Lawmakers—despite last-minute talks—leave for recess without health care reform deal

Daily Briefing

House lawmakers on Thursday began their spring recess without reaching an agreement on the failed American Health Care Act (AHCA), but they advanced an amendment that GOP leaders hope will bolster Republican support for the bill.

The amendment, which the House Rules Committee approved Thursday, comes after House GOP leaders last month pulled the AHCA, which would repeal and replace the Affordable Care Act (ACA), from consideration after failing to gain enough votes to advance the bill. Members of the conservative House Freedom Caucus opposed the bill because they felt it did not do enough to repeal the ACA, while some moderate GOP lawmakers objected to the bill over concerns it would repeal provisions that provide health benefits to their constituents.

White House officials and Republican lawmakers this week struck up new discussions about potential changes to the AHCA. House Speaker Paul Ryan (R-Wis.) on Thursday said the new amendment marks "progress," but added that Republicans "have more work to do" and conversations regarding the AHCA will "continue to take place."

White House press secretary Sean Spicer on Thursday said the Trump administration "feel[s] very good about where the discussion is going."

Amendment details

The amendment, which the administration proposed and Republican Reps. Gary Palmer (Ala.) and David Schweikert (Ariz.) co-sponsored, would establish a $15 billion risk-sharing program, called the Federal Invisible Risk Sharing Program, intended to subsidize health plans over a decade for costly expenses from individuals with serious medical conditions. The amendment would give the HHS secretary the authority to determine how payments under the program would be calculated and distributed to insurers.

According to Bloomberg, the amendment would transition the program's operation from the federal government to the states in 2020.

The program, Bloomberg reports, would resemble a smaller version of the ACA's reinsurance program, which doled out $7.9 billion to insurers for 2014 and $7.8 billion to the companies for 2015. Nicholas Bagley, a professor at the University of Michigan Law School, tweeted, "It's as if Congress wanted to reinstitute the [ACA's] risk corridor and reinsurance programs, but couldn't bring itself to use those words."

However, some industry experts called the proposed funding level inadequate. Timothy Jost, a law professor emeritus at Washington and Lee University, said the amendment "could be very helpful to reducing insurance premiums and keeping insurers in the game, if it were adequately funded."

Amendment alone might not be enough to pass AHCA

Congressional leaders expressed hope that the amendment would bolster support for the AHCA. Ryan on Thursday said, "This brings us closer to the final agreement that we all want to achieve."

However, some key lawmakers who have opposed the AHCA have not indicated whether the amendment will convince them to support the larger bill.

Freedom Caucus Chair Mark Meadows (R-N.C.) on Thursday called the amendment "a step in the right direction, but certainly not the final step." He indicated that his caucus would support the amendment and the AHCA if additional changes are made that would allow states to seek exemptions from some ACA regulations, such as the law's community rating provision and the so-called  "Essential Health Benefits" provision. If those changes are made, he said Thursday, "the majority, if not all of the Freedom Caucus, will vote for this bill."

Rep. Tom MacAurthur (R-N.J.)—co-chair of the Tuesday Group, a caucus of moderate Republicans who also opposed the AHCA—did not indicate whether lawmakers in the group would support the ACHA with the amendment, but called the amendment "a good idea" that "belongs in the bill." However, he added, "The reality is we're still needing to find an ultimate conclusion before we can vote on this bill, and we're not there yet obviously."

According to the New York Times, Vice President Pence, who proposed the amendment to congressional leaders on Wednesday, also has proposed allowing the waivers that Freedom Caucus members have indicated would sway them to support the AHCA. However, moderate Republicans have opposed allowing states to seek waivers from the ACA's community ratings provision, and Rep. Patrick McHenry (R-N.C), the House GOP's chief deputy whip, on Wednesday said adding a measure to allow such waivers to the AHCA would cause GOP leaders to lose more votes on the bill than they could gain.

Support for ACA reaches new high, poll finds

According to Roll Call, Ryan when asked about such waivers on Thursday declined to offer an opinion, but said he "believe[d] that there are additional reforms and ideas" that can both "protect people with pre-existing conditions and continue to lower premiums and give states flexibility so that more insurers can come into the marketplace."

Congress recesses without further action

Congress on Thursday recessed for two weeks, but GOP leaders have said they would not rule out the possibility of returning from the recess early to vote on the bill.

According to the Associated Press, House Majority Leader Kevin McCarthy (R-Calif.) in an email sent to GOP lawmakers said Republican leaders would "advise members immediately and give [them] sufficient time to return to" Capitol Hill if a deal is reached on the AHCA.

According to the Washington Post's "PowerPost," Pence has told lawmakers that President Trump wants to move quickly on the amendment so momentum on repealing the ACA is not lost.

Democrats criticize GOP for rushing to move on amendment

Democratic lawmakers criticized GOP leaders for rushing to move on the amendment before Congress' recess.

Rep. James McGovern, (D-Mass.) said, "There was no vetting at all, no process whatsoever. Just a couple of good ol' boys with a typewriter saying, 'Maybe this will work.'" He added, "I guess what my Republican friends want is to have something to point to before the two-week recess. But this isn't a solution."

(McPherson, Roll Call, 4/6; Howell, Washington Times, 4/6; Winfield Cunningham et al., "PowerPost," Washington Post, 4/6; Morgan, Reuters, 4/6; Tracer/Edgerton, Bloomberg, 4/6; Beavers, The Hill, 4/6; Reuters/CNBC, 4/6; Steinhauer/Pear, New York Times, 4/5; Alonso-Zaldivar/Fram, AP/Sacramento Bee, 4/6; Howell/McLaughlin, Washington Times, 4/6; Howell/McLaughlin, Washington Times, 4/6; Hackman/Andrews, Wall Street Journal, 4/6).

With 'repeal and replace' on hold (for now), what’s next for health reform?

Eric Cragun

The House GOP's first proposal to repeal and replace the Affordable Care Act was withdrawn without a vote, but that doesn't mean the discussions around health reform are over.

Join our panel of experts on April 10 to hear about up-to-the-minute developments, what President Trump and Congress still may do to stabilize or roll back the ACA, what other policy issues might now enter the spotlight, and what this all means for provider strategy.

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