May 3, 2017

New life for the AHCA? Some lawmakers just flipped to 'Yes'

Daily Briefing

Rep. Fred Upton (R-Mich.), a prominent Republican lawmaker who had announced his opposition to the latest version of the American Health Care Act (AHCA), is working on an amendment aimed at addressing his concerns over the proposal's potential effect on coverage for people with pre-existing medical conditions.

Upton is one of several Republican lawmakers who have come out in opposition of an earlier amendment to the AHCA crafted by Reps. Tom MacArthur (R-N.J.), co-chair of the moderate Tuesday Group, and Mark Meadows (R-N.C.), chair of the conservative House Freedom Caucus. That proposal, known as the MacArthur amendment, had won over the roughly 30 conservatives in the Freedom Caucus who had initially opposed the AHCA, but appears to have driven away some moderate Republicans.

According to the Associated Press, the vote count as of Tuesday night had 21 GOP lawmakers opposing the plan and at least 11 others undecided. The Washington Post's "PowerPost" had as many as 22 Republicans being undecided or unclear on whether they will support the plan. House Republicans need 216 votes to pass the AHCA, meaning without any Democratic votes, Republicans can afford to lose only 22 votes from their own party.

Latest concerns

Many of the latest defections stem from how the MacArthur amendment would affect individuals with pre-existing conditions. Under the ACA, insurers are barred from denying coverage to individuals based on a pre-existing medical condition and from charging such individuals more for their coverage.

The MacArthur amendment would allow states to apply for a federal waiver that would allow insurers to impose health status underwriting on individuals who allow their coverage to lapse for at least 63 days; such underwriting would replace the AHCA's provision that would impose a 30 percent premium penalty on individuals who do not maintain continuous coverage. While the amendment includes language that would prohibit insurers from refusing coverage to individuals with pre-existing conditions, several industry experts have noted that health status underwriting could effectively make coverage unaffordable for such individuals.

The issue gained further national prominence Monday night when late-night TV show host Jimmy Kimmel shared the story of his son's recent birth and subsequent diagnosis of a heart condition, which Kimmel characterized as a pre-existing condition that might prevent his son from gaining access to health insurance. Kimmel ended his opening monologue by calling on lawmakers not to jeopardize the pre-existing conditions protections established under the ACA.

Upton on Tuesday told a local radio show, "I cannot support this bill with this provision in it."

Upton's amendment

Upton's proposal has not been publicly released, and media reports conflict on what exactly it would do.

The Associated Press reports that Upton said his amendment would provide $8 billion to cover individuals with pre-existing conditions over five years by helping people with pre-existing medical conditions pay for their premiums in states that opt to allow insurers to conduct health status underwriting. However, according to Axios, the fund would be used to help individuals who get priced out of the market pay the penalty for being previously uninsured. Upton said he is working on the proposal with Rep. Billy Long (R-Mo.), who also opposes the MacArthur amendment.

After a meeting with President Trump on Wednesday, the two lawmakers said they have flipped on the vote and will support the AHCA with their proposed changes, Politico reports.

According to CNN, a House Energy and Commerce Committee source said the panel is offering technical drafting guidance on Upton's proposal, but cautioned that as of Wednesday morning, the amendment had not been finalized.

House Speaker Paul Ryan (R-Wis.) on Wednesday reiterated that lawmakers are making progress on a final bill to repeal and replace the ACA. "Upton identified something he thinks will make the bill better," Ryan said, adding, "What we're doing is listening to our members, finding where that sweet spot of consensus is and driving there."

House Majority Whip Steve Scalise (R-La.) on Wednesday suggested lawmakers were nearing a deal that would allow them to move forward with a vote. "I think we have a solution that addresses some of their concerns, gives us the ability to bring more people into the yes column without losing any of our current yes votes."

House readies for quick vote

While House leaders have declined to specify a timeline for bringing a final bill to the floor for a vote, the House on Tuesday voted largely along party lines to waive a procedural rule requiring lawmakers to wait at least one day before voting on a measure approved by the House Rules Committee, which determines how legislation is considered on the floor. Republicans largely voted to waive the rule, while Democrats largely voted to keep the rule in place.

The House Rules Committee has not yet considered either the MacArthur amendment or Upton's plan. However, the procedural change would allow the House to vote on a measure the same day it is approved by the committee. House lawmakers currently are scheduled to recess Thursday until May 16 (Fram, AP/Washington Times, 5/2; Eilperin, "To Your Health," Washington Post, 5/2; Sullivan/Weigel, "PowerPost," Washington Post, 5/2; Marcos, "Floor Action Blog," The Hill, 5/2; Sullivan/Hellmann, The Hill, 5/2; Sullivan, The Hill, 5/3; Lee/Zeleny, CNN, 5/3; Owens/Swan, Axios, 5/3; Bresnahan et al., Politico, 5/3; Steinhauer et al., New York Times, 5/3; House et. al, Bloomberg, 5/3).

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