A White House effort to win House approval next week for an ObamaCare repeal bill is running head-on into a divided GOP conference struggling to reconcile its differences.
While centrist Rep. Tom MacArthur (R-N.J.) and conservative Rep. Mark Meadows (R-N.C.) say they are close to a deal, other Republicans say they are not a part of the agreement and that MacArthur is not bringing other centrists along with him.
Republican lawmakers will hold a conference call on Saturday to discuss the issue.
They’re also likely to confer on another problem: keeping the government open.
Even as the conference seeks to revive ObamaCare repeal legislation, it faces an April 28 deadline to pass legislation that prevents a government shutdown.
And hanging over everything is pressure from a Trump administration that wants to put more points on the board before its 100th day in office, April 29.
Here’s where things stand on ObamaCare ahead of what could be a very busy week.
New activity, old problem
Despite the burst of activity, Republicans are running into the same fundamental problem on ObamaCare. Their conference is divided over how much of the law to keep in place.
The conservative Freedom Caucus, led by Meadows, is pushing to give states the option to opt out of several ObamaCare requirements, including one meant to keep prices down for people with pre-existing conditions. But much of the rest of the conference wants to preserve those popular provisions.
After chatter from the White House about a vote as soon as next week, President Trump on Friday seemed more downbeat, saying at an executive order signing that there is “no particular rush.”
“It doesn’t matter if it’s next week,” Trump said.
Community rating controversy
One of the biggest controversies splitting conservatives from centrists has to do an insurance practice called community rating.
The Affordable Care Act uses it to prevent insurers from charging customers different premiums based on their health conditions.
MacArthur’s proposal would allow states to opt out of that requirement, as long as they also have a high-risk pool that sick people priced out of the market could potentially use to purchase insurance.
Many other Republicans are leery of granting states waivers for community rating.
It is the main factor that keeps people with pre-existing conditions from being priced out of coverage, and without it, the number of people insured could drop.
There are also political concerns.
Democrats are prepared to attack the GOP for undermining protections for people with pre-existing conditions, a popular part of ObamaCare.
While a summary of the MacArthur-Meadows proposal states that the law would still prevent insurers from dropping people with pre-existing conditions, those protections would be meaningless, critics say, if the community rating provision is gutted.
Essential health benefits
The MacArthur proposal would also allow states to opt out of "essential health benefits," which require that insurers cover a minimum set of services like mental healthcare and certain prescription drugs.
Conservatives argue allowing states to choose to opt out those provisions would bring down premiums for young, healthy people.
Rep. Rodney Davis (R-Ill.), a member of centrist Tuesday Group, said Friday he was unaware of any deal.
“I wish I knew what was in this so-called deal,” Davis told CNN's “New Day.” “I think we're still negotiating. I think we’re still talking about what plan is going to work to get the votes to pass the House.”
The Energy and Commerce Committee, which drafted the original reform legislation, is providing technical drafting guidance with the amendment, a committee aide told The Hill.
Freedom Caucus is positive
The Freedom Caucus has taken a more positive view of the changes and expressed hope its members can get on board with the bill.
Rep. Dave Brat (R-Va.), a member of the caucus, suggested that the proposed changes would go a long way toward getting conservatives to support the bill.
“It just allows states to opt out of some of the [regulations] to bring down price. And so those are two of the big pieces,” Brat said on CNN Friday. “A couple little pieces on the regulatory framework, and then I think we can all get to yes. It's not really a new bill — it's the same fundamental bill, but a few pretty significant amendments to it.”
The changes being discussed are similar to what Vice President Pence offered to the Freedom Caucus earlier this month, before Congress's spring recess.
That offer led to an earlier round of renewed hope, but ended up falling apart.
Illustrating the effect of doing away with community rating, a study from the liberal Center for American Progress this week predicted that allowing states to opt out of the provision would lead to sharp premium increases for sick people, such as roughly $4,000 for those with asthma or as much as $71,000 for those with severe cancer.
Rep. Patrick McHenry (R-N.C.), the chief deputy whip, said earlier this month that the Freedom Caucus's demands on that front were a “bridge too far for our members.”
A GOP aide said Thursday that the situation had not changed since then. “I don’t know that the state of play has really changed over the recess,” the aide said.