The Growing Gap Between the House and the White House on Health Care
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George Core
2017-04-21 00:10:08 UTC
Raw Message
The Growing Gap Between the House and the White House on Health

There’s another potential deal to repeal and replace Obamacare,
but despite the wishes of the White House, it’s unlikely to
break the stalemate in the House anytime soon.
Andrew Harnik / AP

Russell Berman 4:24 PM ET

President Trump desperately wants a deal on health care, and he
wants the House to pass it next week before his first 100 days
in the White House are out.

That much is clear from the reports of a tentative agreement
between the leader of the conservative House Freedom Caucus,
Representative Mark Meadows of North Carolina, and a co-
chairman of the moderate Tuesday Group, Representative Tom
MacArthur of New Jersey, to break a stalemate over the GOP’s
American Health Care Act.

What’s also clear, however, is that the House Republican
leadership—the lawmakers that both call and count the votes in
Congress—shares neither the optimism nor the urgency of the
White House. Speaker Paul Ryan said after a speech in London on
Wednesday that Republicans were putting “the finishing touches”
on a new proposal, after the party stumbled badly last month on
its initial attempt to repeal and replace the Affordable Care
Act. But on Thursday, a senior GOP congressional aide dampened
expectations for the bill, which a senior White House official
told The Washington Post could receive a House vote as soon as
the middle of next week.
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“The question is whether it can get 216 votes in the House and
the answer isn’t clear at this time,” the aide wrote me in an
email. “There is no legislative text and therefore no agreement
to do a whip count on.”

These mixed signals are the latest example of the yawning
expectations gap between Trump and Ryan over what Congress can
achieve on the vexing question of health care. Reluctant to
acknowledge defeat, the president has repeatedly insisted over
the last several weeks that an agreement is close at hand, that
the differences separating the hardliners in the Freedom Caucus
from the more pragmatic and electorally vulnerable moderates
are bridgeable. “It’s evolving,” the president said Thursday
during a press conference, in which he denied there was ever “a
give-up” on the issue. (His top aides had told House
Republicans that Trump would move on from health care if they
didn’t pass the bill last month.) “The plan gets better and
better and better, and it’s gotten really, really good, and a
lot of people are liking it a lot,” Trump said. “We have a good
chance of getting it soon.”

But while Ryan has made a public show of confidence, his office
has been much more skeptical about the prospects for reviving
the AHCA, having seen first-hand how narrow the path is for
writing a policy that can win the votes of conservatives
without sacrificing the support of Republicans closer to the
political center. Conservative activists also sense that the
speaker is fearful of being burned again on a bill for which he
expended significant political capital and lost.

The basic dynamics haven’t changed: Members of the Freedom
Caucus want to repeal more of Obamacare’s insurance mandates
than the AHCA initially scrapped. They argue that doing so is
central to the GOP’s long-standing promise of a complete repeal
and that the requirements that insurance companies cover
certain essential health benefits and accept even the sickest
customers are driving up premiums for millions of Americans.
Moderates, however, are leery of breaking another pledge
Republicans have made repeatedly—that they would not do away
with Obamacare’s popular protections for people with
preexisting conditions.

As reported by The Huffington Post and Politico, the agreement
Meadows and MacArthur have struck would deal with the mandates
by letting the states opt out of many of them, so long as they
demonstrated that an alternative policy would seek to lower
premium costs and expand insurance coverage. In theory, the
compromise would let conservatives declare they have weakened
Obamacare’s mandates and given states more power over health-
care policy. And moderates hailing from Democratic states could
assure their constituents that, in all likelihood, they would
not lose the protections they currently have because their
governors or legislatures would not opt out of the federal

But the proposal faces any number of pitfalls, both practically
and politically.

The Conservative Quandary

Meadows, the third-term North Carolina conservative, genuinely
wants to play the role of dealmaker. Despite the president’s
occasional ribbing, he’s on good terms with Trump and would
like nothing more than to win his praise by delivering a
health-care deal that once seemed dead. But it remains an open
question just how much sway Meadows has with his own members in
the Freedom Caucus. He has claimed that he could have delivered
some two dozen votes for an earlier proposal from Vice
President Mike Pence, but the House GOP leadership has
privately voiced doubts about his influence. It’s clear there
are some members of the Freedom Caucus, such as Representative
Justin Amash of Michigan, who are unlikely to support any bill
that retains the structure of the AHCA. The GOP can lose no
more than 22 votes, and a number of moderates are similarly
opposed to the legislation because it goes too far to the right
at it is.

Wrong Deal-Maker?

MacArthur may be a co-chairman of the Tuesday Group, but he was
already supporting the House GOP bill, so his backing of a
compromise doesn’t automatically alter the dynamic on the
center aisle of the Republican conference. The leadership was
well short of the 216 votes it needed in March, and party
officials have warned that just about any deal they struck with
the Freedom Caucus would result in a net loss of votes because
it would scare moderates away. MacArthur’s endorsement could
help prevent that kind of exodus, but it’s unlikely to flip
many votes among the dozen or so moderates who were previously

Moderates have even more reason to be wary because
conservatives are itching to lay the failure of Obamacare
repeal at their feet after the Freedom Caucus drew the bulk of
the blame last month. After Meadows endorsed Pence’s proposal
in March, activist groups like Heritage Action and the Club for
Growth attacked GOP centrists for blocking progress on the

Political Suicide?

Republicans in the White House and on Capitol Hill were plainly
embarrassed by their failure on health care the first time
around, when they abandoned an ironclad promise without so much
as a vote. The whiff had a much bigger ripple effect on their
agenda, threatening Trump’s even higher priority of tax reform.

But to political analysts, the idea that the president and the
House GOP would revive the AHCA is akin to escaping a burning
building and then rushing back in for no good reason. The
original bill had a ghastly 17 percent approval rating and had
virtually no natural constituency other than Democratic
activists eager to make Republicans pay for supporting it. The
legislation has continued to dominate town-hall events during
the current congressional recess, prompting lawmakers who had
been on the fence, like Representative Jeff Denham of
California, to declare their opposition after the fact.

Within hours of the reported agreement, statements denouncing
the policy flooded in from progressive groups accusing
Republicans of breaking their promise to people with
preexisting conditions and trying to paper over their deceit.
“The MacArthur amendment makes a bad bill even worse,” wrote
the co-directors of Health Care for America Now, Margarida
Jorge and Ethan Rome. “The only people this amendment will help
are the members of Congress scrambling to pass any repeal bill
for partisan political reasons, no matter how bad it is for
their constituents. Millions will still lose their health
insurance. States can still avoid critical consumer
protections. Insurers can still refuse to provide basic
coverage, institute annual and lifetime caps on the care they
cover, and charge people with preexisting conditions more just
because they need care, effectively pricing people out of the
market.” Jessica Mackler, the president of American Bridge,
called the idea of letting states opt out of Obamacare mandates
“an insidious backdoor to hammer individuals with preexisting
conditions and ending coverage for essential services like
hospitalization, maternity care, and prescription drugs.”

The Specter of a Government Shutdown

As I wrote on Tuesday, Congress has a more urgent matter to
consider when lawmakers return to Washington next week: They’ll
have just a few days to avert a partial shutdown of the federal
government. Funding expires on April 28, and the two parties
have yet to announce a deal to appropriate money for the
remaining five months of the fiscal year. At minimum, Congress
must pass a stopgap measure to buy more time for negotiations
if they want to keep the government open, and Republican
leaders have said this will be their top priority in the days
ahead. Asked on Thursday whether he wanted a vote on health
care or on a funding deal next week, Trump replied: “I want to
get both. Are you shocked?”

Remember the Senate?

Lest the president forget, the U.S. Congress is a bicameral
legislature. Even if the House were to pass a major health-care
bill in time for Trump’s 100-day marker, the legislation would
still be a long way from becoming law. The proposal’s prospects
were already precarious with the narrow Republican majority in
the Senate, and the changes under consideration in the House
could further imperil it in the upper chamber. Passage in the
House would likely spur another several weeks of negotiations,
if not months. Trump may be impatient to demonstrate progress
on health care, but as he learned when he initially tried to
shoehorn a House vote last month, wishing Congress would do
something doesn’t make it so.

Jeanne Douglas
2017-04-21 11:05:50 UTC
Raw Message
Post by George Core
The Growing Gap Between the House and the White House on Health
There?s another potential deal to repeal and replace Obamacare,
but despite the wishes of the White House, it?s unlikely to
break the stalemate in the House anytime soon.
Andrew Harnik / AP
What I've seen so far is that the new "bill" throws those with pre-existing conditions even harder under the bus.
Posted by Mimo Usenet Browser v0.2.5
Bob Officer
2017-04-21 19:08:01 UTC
Raw Message
Post by Jeanne Douglas
Post by George Core
The Growing Gap Between the House and the White House on Health
There?s another potential deal to repeal and replace Obamacare,
but despite the wishes of the White House, it?s unlikely to
break the stalemate in the House anytime soon.
Andrew Harnik / AP
What I've seen so far is that the new "bill" throws those with
pre-existing conditions even harder under the bus.
The premise that the pool of insurance money belongs to insurance company
is just wrong. Pooled money administered by a company provides a spears out
risk of cost. There is no need for a profit and millions of dollars to

Singer payer makes real sense. Cover everyone under one pool of funds.
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