White House, Republicans Weigh Benefits Changes to Health Care Bill

The White House is talking with House conservatives about last-minute changes to the embattled GOP health-care bill aimed at wooing enough holdouts to secure House passage.

Lawmakers and Trump administration officials are discussing revisions to “essential benefits” requirements in Obamacare, according to members of Congress and a White House official familiar with the discussions. The negotiations dragged late into Wednesday night, and Republicans postponed until Thursday a key procedural step before the bill gets to the floor.

Holdouts in the House Freedom Caucus also pushed for changes in Obamacare’s requirements that insurers cover people with pre-existing conditions, but the White House gave them a hard no, according to a White House official.

Mark Meadows of North Carolina, who chairs the House Freedom Caucus, disputed that. “Addressing pre-existing conditions has always been a requirement for any replacement plan that HFC would support,” he said late Wednesday.

Meadows said that there was no deal yet with the White House, and that it was too early to tell if one would be reached overnight or Thursday. Members of the Freedom Caucus are scheduled to go to the White House Thursday morning, the same day the House is scheduled to vote on the measure.

“The president and I came to an agreement in principle,” Meadows told Fox News late Wednesday. “What we’re trying to do now is to make sure that — that our agreement is something that can be executed in a way that passes the Senate.”

Last Procedural Step

The House Rules Committee, which will make final changes to the bill before it gets a floor vote, postponed a session that lasted for more than 12 hours on Wednesday as the talks with the conservatives dragged on. The committee plans to reconvene Thursday, finalize changes to the bill and set the rules for how it will be debated in the full House.

President Donald Trump and House Speaker Paul Ryan have been working to win over conservative rebels who stand in the way of their Obamacare replacement measure. Late Wednesday, Meadows said there are signs of movement.

“I’m very encouraged that we might be seeing some real headway,” he told reporters. “I can tell you this, the message needs to be that the president is fully engaged in making a big difference.”

Earlier Meadows had said the measure lacked enough votes for passage.

Losing Moderates?

Yet as Trump and Ryan pick up conservative members with some of the potential changes, they risk losing moderates. Republican Representative Charlie Dent of Pennsylvania, leader of the moderate Tuesday Group in the House, said Wednesday night he would oppose the bill.

“I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals,” he said in a statement.

Meadows and other conservative Freedom Caucus members have been demanding changes to the “essential benefits” portion of the Affordable Care Act, which requires insurers to cover 10 categories of services. Those services include hospitalization, ambulance services, maternity care, pediatric services, mental health and substance abuse treatment, prescription drugs, rehabilitative care and laboratory services.

The goal of limiting the required essential health benefits would be to bring down health insurance premiums.

Senate Rules

It’s unclear whether changes to these requirements could survive procedural challenges in the Senate.

“What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” Matt House, a spokesman for Senate Democratic leader Chuck Schumer, said in a statement late Wednesday. “It will require 60 votes to repeal these protections, and the votes just aren’t there in the Senate.”

Earlier Wednesday, Alyssa Farah, a spokeswoman for the Freedom Caucus, wrote on Twitter that more than 25 members of the group remain opposed — enough to defeat the bill — and that GOP leaders should “start over.”

Trump met with nearly a dozen Republican lawmakers Wednesday morning who still have concerns about the legislation. Separately, about 26 Republicans met with senior White House officials, including Vice President Mike Pence.

‘To the Closer’

“We’re bringing them to the closer,” Representative Patrick McHenry, a senior member of the House GOP vote-counting team, told reporters at the White House, referring to Trump.

White House Press Secretary Sean Spicer noted that at least two lawmakers who had expressed reservations as recently as Tuesday are now backing the bill.

“I think the trajectory is going very well for us,” he told reporters. “This is the only way that we will repeal and replace Obamacare.”

But the Freedom Caucus has said that the current bill is not a complete enough repeal of the health-care law. The floor vote scheduled for Thursday could be the first sign of whether the caucus will be able to enforce its conservative principles in the age of Trump.

“How can you talk about repealing the ACA, Obamacare, without repealing the essential benefits and the guaranteed issue?” Representative Scott Perry of Pennsylvania said, referring to the required benefit packages under the Affordable Care Act and the law’s preexisting condition rules.

Freedom Caucus members said White House officials made the pitch that conservatives should pass the bill so that the Senate can amend it and address their concerns, but several lawmakers said they weren’t buying it.

“Pence made a play for more support for the bill based on the Senate being able to change it,” Representative Randy Weber said in an interview, adding that he’s still a no. “That’s a hard row to hoe.”

“Because we’d like for it to be as strong as possible going over to the Senate,” he added.

Do It Now

Weber said many Republicans were elected to Congress because of Obamacare, and said they can’t wait years for costs to come down. “In 10 years none of us will be here,” he said. “Probably at this rate, in two years none of us will be here.”

If the Freedom Caucus is unable to win major changes — or block the measure — it could mark a double victory for Ryan by diminishing the influence of a group that led the ouster of his predecessor, John Boehner.

Indeed, a Republican aide said that House leaders see the prospect of damaging the clout of the Freedom Caucus as a satisfying byproduct of passing the health-care measure.

Last Holdouts

So far, about a dozen members of the Freedom Caucus have come around to embrace the bill. The group claims to have roughly 40 members, but doesn’t publish an official roster.

Whether any of the Freedom Caucus’s remaining holdouts will drop their opposition to the health-care measure before Thursday’s vote will determine the outcome. Those holdouts are being cheered on by several Senate conservatives, including Rand Paul of Kentucky and Mike Lee of Utah.

Meadows was singled out as a holdout by Trump during a closed-door meeting with House Republicans Tuesday morning.

Representative Richard Hudson, a Republican from North Carolina, said the Freedom Caucus will damage itself if it ends up blocking the measure, though he predicts most members eventually will come on board.

“How can they go back and face their constituents if they’re the reason we didn’t get the most significant entitlement reform in a generation, if they’re the reason we didn’t keep our promise of repealing Obamacare,” Hudson said. “It defies me to understand where they’re coming from.”