Donald Trump’s archconservative allies in the House are trying to keep the Obamacare repeal dream alive — but one key member is also starting discussions about fixing the law.
Freedom Caucus Chair Rep. Mark Meadows has started negotiating a deal with a top House moderate, Rep. Tom MacArthur (R-NJ), which would work to stabilize Obamacare’s individual markets, funding key payments to insurers while giving states more flexibility for their own health care programs.
Meanwhile, on Friday, while most of Congress was home on recess, three House Freedom Caucus members — Reps. Jim Jordan (R-OH), Scott Perry (PA), Tom Garrett (VA) — were on the House floor introducing and signing a discharge petition that would force the House to vote on a clean Obamacare repeal bill.
Republicans have been stuck in an intra-party battle between reviving Obamacare repeal or moving on and taking small steps to stabilize the law since last month’s failure in the Senate. The Freedom Caucus is now at the heart of that predicament: While they make a very public gesture to force another repeal vote, their leader is also setting up a scenario in which the law could largely remain in place.
There is a new more moderate plan in nascent stages
Meadows has entered into initial talks with MacArthur about a much more modest health care bill that would actually be designed to stabilize Obamacare, as Axios first reported.
A House aide emphasized that these talks are in their early stages and do not represent an endorsement from the full Freedom Caucus.
The outline of the emerging deal is pretty simple, per the aide:
- Congress would authorize cost-sharing reduction payments, which compensate insurers for providing discounts on out-of-pocket costs for lower-income customers.
- In exchange, states would be given more flexibility under an existing Obamacare waiver program to pursue their own health care policies.
The cost-sharing reduction payments, which Vox has explained in great detail, have been repeatedly threatened by Trump in recent weeks. Because of an ongoing lawsuit, Trump could cut off the payments at any time, which could cause insurers to either hike their premiums or drop out of the market altogether. Some top Republicans in Congress have urged Trump not to follow through on the threat, but congressional action is the only sure way to prevent it.
But other Republicans, particularly the most ardent anti-Obamacare members in the Freedom Caucus, would be reluctant to support funding for the health care law without getting anything in return. So their win in this deal would be more flexibility for the state waivers already available under Obamacare.
Conservatives have been seeking such state flexibility throughout the Obamacare repeal debate — it’s not yet clear how the new proposal would differ from previous iterations. There is a wide range of possibilities: The waivers could give states a blank check to undo Obamacare’s insurance regulations or they could leave most of the law’s safeguards in place. It would depend entirely on the specific legislative language.
Part of the theory for conservatives, per the House aide, is that addressing the waivers in the stabilization bill would eliminate the need to deal with them in a bigger repeal-and-replace bill that Meadows and others still hope to revive. Those proposals have consistently run into trouble under the Senate’s procedural rules, which limit what policies Republicans can include in a “budget reconciliation” bill that needs only 50 votes to advance in the upper chamber.
But it’s not clear how this actually helps Republicans get the 50th vote in the Senate for any Obamacare repeal bill. The objections from the Republican senators who voted against three different repeal bills last month were not about the waiver proposals.
Republican leaders also have a packed schedule for the foreseeable future, with government funding and the federal debt ceiling on tap in September, and seem genuinely eager to move onto other issues like tax reform rather than continuing to litigate health care.
So in the end, this could wind up being the best deal the Freedom Caucus and other anti-Obamacare Republicans can get. State flexibility, in exchange for making sure the health care law they hate so deeply doesn’t collapse.
Of course, it could still be a struggle. The leader of another conservative group in the House tweeted his skepticism about the nascent deal shortly after it went public.
Meanwhile, the Freedom Caucus is also making its party walk the plank on clean repeal
Meanwhile, the discharge petition is an attempt to force a vote on a proposal the Senate already failed to pass in late July (seven Republicans voted against a proposal to repeal Obamacare and replace it later). But that vote hasn’t deterred House conservatives from pushing forward.
If they get 218 signatures on their petition, House Leadership would have to bring a clean Obamacare repeal bill to a full floor for a vote. That vote would be difficult for the dozens of moderate Republicans in vulnerable House seats, and it wouldn’t provide a clear path to repealing and replacing the health care law.
The clean repeal proposal would “wipe the health law’s coverage expansion off the books without a replacement in 2020,” Vox’s Sarah Kliff wrote, in what Republicans have named a “repeal and delay” strategy. However, the Congressional Budget Office, which evaluates the impact of bills, says it would still leave 17 million less people insured in the first year.
The House voted to pass a repeal bill in 2015 knowing it would go nowhere under then president Barack Obama. But voting for a repeal bill now is more than just a symbolic statement. There is a sizable contingent of moderates worried about any bill that would amount in a loss of health insurance coverage — including the most politically vulnerable members of the House, such as Rep. Darrell Issa.
Forcing vulnerable moderate members into yet another difficult vote on health care is a big risk for a Republican Party looking to keep their majority. But the Freedom Caucus, adamant on making a statement that they still believe in repealing Obamacare, hopes this petition would bully members into a party-line vote. Even if it fails, a signed petition will show who has flipped on Obamacare repeal between 2015 and 2017, one Freedom Caucus aide said.
Freedom Caucus members think that the House passing the repeal bill would put added pressure on senators to change their votes if the measure came up again — but there isn’t any indication that would be the case.
House Leadership doesn’t appear to be behind the new attempt. “The House has already passed a plan to repeal and replace Obamacare," House Speaker Paul Ryan’s spokesperson AshLee Strong told Vox, referencing the 2015 vote.
In other words, there is no need to put members through it again now.
So while with one hand archconservatives members are taking steps down a road that could lead to Obamacare largely remaining the law of the land, they are hankering for another showdown with their colleagues over Obamacare repeal.