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April 28, 2017

AHCA vote will not happen today, GOP leadership says

Daily Briefing

House Republicans are not expected to vote this week on their revised bill to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan (R-Wis.) during his press conference on Thursday had left the door open for a potential vote, saying, "We're going to go when we have the votes." But shortly after 10 p.m. that evening House Majority Leader Kevin McCarthy (R-Calif.) told reporters after a meeting with Ryan and top lieutenants, "We are not voting on health care tomorrow."

The decision came as House GOP leaders continued to struggle to secure the 216 votes needed to pass the American Health Care Act (AHCA) and after House Democratic Whip Steny Hoyer (D-Md.) warned on Thursday that if Republicans attempted to bring their health care reform bill to the floor for a vote Friday or Saturday he would "oppose a one-week Continuing Resolution and ... advise House Democrats to oppose it as well."

On Friday, the House and Senate passed legislation to continue funding the federal government (H.J. Res. 99) to continue funding the federal government through May 5, sending it to President Trump to sign into law before the 11:59 p.m. deadline to avoid a government shutdown.

A look at the numbers

House Republicans need 216 votes to pass the AHCA, meaning without any Democratic votes Republicans can only afford to lose 22 votes from their own party if every member votes. House Oversight and Government Reform Committee Chair Jason Chaffetz (R-Utah) is expected to be absent for at least one week for foot surgery. In his absence, House Republicans could only afford to lose 21 votes, the Huffington Post reports.

The latest amendment to the AHCAwhich has yet to advance out of the House Rules Committeewon over the roughly 30 conservatives in the House Freedom Caucus whose initial opposition forced Ryan to pull the bill from consideration last month. At the same time, the new amendment appears to have driven away some moderate Republicans, the New York Times reports—even though it was negotiated by Rep. Tom MacArthur (R-N.J.), co-chair of the moderate Tuesday Group,.

For instance, Rep. Mario Diaz-Balart (R-Fla.) told reporters Thursday, "I was a yes before, but there are a lot of red flags" with the amendment, such as how the bill would handle people with pre-existing conditions. According to the The Hill, some moderate Republicans say MacArthur's changes bring the bill too far to the right, while other Republicansincluding conservative Rep. Walter Jones (R-N.C.)say they do not want to vote on the revised bill until it has been scored by the Congressional Budget Office.

As of Thursday night, the New York Times reports at least 18 Republican lawmakers had publicly stated their opposition to the bill; Politico Pro reports at least 15 had come out against it, with about 20 leaning no and several others expressing uncertainty; and Roll Call reports at least 18 Republicans oppose the bill, including 13 members of the Tuesday Group. The Hill is reporting a higher number of GOP no votes, saying at least 21 Republicans oppose the bill.

Rep. Pete Sessions (R-Texas), chair of the House Rules Committee, said, "We're going to try and measure three times and saw once," adding, "A lot of people around this town have tried their best to try and rush it, rush it, rush it." The committee has posted the latest AHCA amendment's bill text, but as of Friday at 10:30 a.m., had not scheduled a hearing to consider it.

House Freedom Caucus Chair Mark Meadows (R-N.C.) during a Friday appearance on MSNBC's "Morning Joe" said Republicans were "just a few" votes short. "We're going to continue to work today and tomorrow. I fully anticipate that we'll have a vote in the coming days," he said. Overall, Meadows said, "I don't know that there will be necessarily a lot of fundamental changes" to the bill in either the House or Senate.

More industry stakeholders come out against AHCA amendment

Several health care provider groups and AARP oppose the latest version of the bill, criticizing the potential effects for older U.S. residents and those with pre-existing conditions.

Doctors' groups say draft AHCA amendment could reduce US residents' access to care

James L. Madara, the chief executive of the American Medical Association, said, "Although the MacArthur amendment states that the ban on pre-existing conditions remains intact, this assurance may be illusory, as status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions."

AARP on Thursday released a new analysis that estimated the GOP's plan to use high-risk pools could cause premiums for patients with pre-existing conditions to reach as much as $25,700 annually in 2019.

American Hospital Association in a statement said, "The amendment proposed this week would dramatically worsen the bill" and "put health coverage in jeopardy for many Americans."

America's Essential Hospitals in a statement called the latest changes "[s]imply bad policy that will cut a lifeline ... for millions of Americans" (Kaplan/Pear, New York Times, 4/27; Wong, The Hill, 4/27; Diamond, Politico Pro, 4/28 [subscription required]; Lillis, The Hill, 4/27; Lesniewski, Roll Call, 4/28; McPherson/Mershon, Roll Call, 4/27; Cornwell, Reuters, 4/27; Eilperin/Weigel, Washington Post, 4/27; Andrews/Peterson, Wall Street Journal, 4/27; Sutton, Politico, 4/28; Cowan/Becker, Reuters, 4/27; Fuller, Huffington Post, 4/27).

What does health care reform beyond the ACA look like? Join us on May 2nd

Stuart Clark, Managing Director

The first part of the Health Care Advisory Board’s latest “State of the Union” explores what the Trump administration and GOP-controlled Congress will mean for the future of coverage expansion, payment reform, and federal entitlement programs.

The presentation provides an objective analysis of the next era of health care reform, unpacking the potential futures of Medicare, Medicaid, and the private insurance market—and what those changes would mean for provider strategy. The presentation also includes a detailed assessment of the accomplishments, shortcomings, and unintended consequences of the Obama-era reforms.

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