clock menu more-arrow no yes mobile

Filed under:

House Republicans inch closer to repealing Obamacare

It all comes down to turnout.

Mark Wilson / Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Suddenly, House Republicans sure seem like they are starting to move again on their previously stunted quest to repeal and replace Obamacare.

Where that movement is actually heading is not yet clear. House Republicans do seem to be inching toward a deal that could get enough votes to pass an amended version of the American Health Care Act.

On Wednesday afternoon, in a major breakthrough for the bill, the House Freedom Caucus — a bloc of three dozen archconservatives — collectively endorsed it.

But it isn’t clear if they alone deliver enough votes for the bill to pass. That leaves the AHCA’s fate in the hands of the House’s moderate Republicans.

It comes at a particularly crazy time for Congress. Republicans are floating a new amendment to their health care reform bill the day before the White House reveals more details about its tax reform push — all in the same week the government needs some kind of spending agreement to avoid a shutdown. And this is ahead of President Donald Trump’s first 100 days marker on Saturday.

The breakneck pace creates the appearance that Republicans are working very hard and maybe getting close to a deal. That’s what really matters, in the end. But early reviews are much more mixed: Nobody seems sure House Republicans have actually found a compromise that can pass.

The new amendment tries to solve political problems, but it might create other ones

Text of a reported deal between members of the archconservative and centrist wings leaked on Tuesday night. As Vox’s Sarah Kliff outlined, it would allow states to opt out of some of Obamacare’s insurance rules, which required more comprehensive health coverage while also prohibiting insurers from charging sick people more for insurance than healthy people.

Those parts of Obamacare have been core to the Republican plan’s political problems. The archconservatives, a group called the House Freedom Caucus, wanted them gone. But moderates in the Tuesday Group wanted to keep them and feared the coverage losses that would result from rolling them back.

That disagreement stopped the GOP bill in late March, but leaders from both wings have kept talking over the past month. The White House has also kept the pressure on for the House to reach a deal, after being embarrassed by the bill’s initial failure and amid the president’s desire to secure an early legislative achievement before he hits 100 days in office.

Reports of a near-breakthrough have occurred again and again this month, but Tuesday’s movement feels the most significant. First, the Washington Post reported that the leaders of the Freedom Caucus were on board with the new compromise:

Then the actual legislative text of the compromise leaked to Politico. It was the first time that the new policy, which has been rumored for some time, was actually put into hard language. More Freedom Caucus members said positive things about the bill, per Axios.

But despite this flurry of activity — again, just a few days before the 100-days threshold — it’s not actually clear that the bill has cleared its fundamental hurdle: the 216 votes necessary to pass in the House.

There is still a big gap between the Freedom Caucus and the Tuesday Group

The Freedom Caucus has come around. But then there are the moderates.

One health care lobbyist told me recently that, by their count, more moderate Republicans opposed the original bill than Freedom Caucus members. The new deal, which was negotiated on the moderate side by Congress member Tom MacArthur of New Jersey, who actually already supported the GOP plan, doesn’t give them much in the way of policy wins.

States can opt out of the Obamacare provisions — a win for the Freedom Caucus — but there isn’t a clear victory for the centrists. Many experts don’t believe that setting up high-risk pools, the on-paper protection to make sure people with preexisting conditions are covered, in a nod to moderate concerns, would be foolproof.

“For the moderates, allowing the state to decide is not quite as bad as the feds, but it's close enough,” one health care lobbyist told me. “How can they argue they've protected lives when they just handed the gun to someone else?”

Not to mention: Many moderates were unnerved by the deep Medicaid cuts in the original bill, and those would remain under the compromise.

The other problem: The Tuesday Group doesn’t usually operate as a bloc in the same way that the Freedom Caucus does. So just because MacArthur, who already supported the bill, is on board doesn’t mean that he’ll be joined by his colleagues. If you’re a Republican lawmaker already skittish about the bill, what about the new plan changes your assessment?

“If you promised not to mess with preexisting conditions or cause anyone to lose coverage, how does the MacArthur Amendment get you to yes?” another GOP lobbyist told me. “Plus, MacArthur brings along exactly zero members with him, because that is how the Tuesday Group rolls.”

That aligns with the early public comments from the moderate wing to the new plan.

Other statements from House members on Tuesday night didn’t exactly inspire comments.

Then it becomes a math problem for Republican leaders and the White House. They can only lose 22 votes to get to 216. By the New York Times’ count, 33 Republicans were opposed to the original version of the GOP bill, and many others were either concerned or hadn’t taken a public position.

So even as the new plan wins over the Freedom Caucus, is it actually winning enough votes? What if more moderates start to drop off because they fear attacks saying they are voting to gut protections for sick people? And even if they somehow manage to get enough votes in the House, what happens in the Senate?

A lot seems to be happening on health care, very suddenly. But all it seems to be doing is raising questions.