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Influential Republican Attacks Party’s New Health Care Bill G.O.P. Scrambles as a Crucial Voice Shuns the Latest Health Bill
(about 7 hours later)
WASHINGTON — The former chairman of one of the House committees that drafted legislation to repeal and replace large parts of the Affordable Care Act came out against a new version of the bill on Tuesday, saying the measure now “torpedoes” protections for people with pre-existing medical conditions. WASHINGTON — With two days left before an 11-day recess and no vote scheduled, House Republican leaders worked on Tuesday to win votes one at a time for their latest bill to repeal the Affordable Care Act after an influential Republican voice on health care came out against the measure.
Representative Fred Upton of Michigan, who chaired the House Energy and Commerce Committee as the Affordable Care Act repeal movement built steam, declared on a local radio show, “I cannot support the bill with this provision in it,” just as House Speaker Paul D. Ryan was insisting that the legislation would protect the sick. A failure to get the repeal bill to a vote this week would be the third time that Speaker Paul D. Ryan could not rally his considerable House majority around a legislative priority that Republicans have promised for seven years.
The loss of Mr. Upton, an influential Republican voice on health care, was a huge blow, and it came as Republican leaders faced an onslaught of advocacy groups, political attack ads and even a late-night talk show host, Jimmy Kimmel, saying the bill would harm the nation’s most vulnerable citizens. Republican leaders were ready to move on from health care after the embarrassing collapse of their measure in March, but President Trump pressed Mr. Ryan hard to deliver on a major campaign promise and personally pressured House members to fall into line.
A tearful Mr. Kimmel on Monday night offered up the story of his infant son’s near-death heart surgery, followed by an appeal to Congress not to undermine the Affordable Care Act’s ban on discrimination against people with pre-existing medical conditions. After Mr. Kimmel’s monologue went viral on the Internet, former President Barack Obama piled on, tweeting: If the effort fails, it will greatly weaken the president’s hand on Capitol Hill and cast a shadow across the rest of his legislative agenda, especially the deep tax cuts and rewrite of the tax code that he has proposed — and that are likely to be no easier to tackle than health care.
Mr. Upton was explicit: The concessions made to win over the hard-line conservatives in the House Freedom Caucus were costing the leadership support from more moderate Republicans. Representative Fred Upton of Michigan was only the latest Republican defector, but he carries more sway than most. The former chairman of one of the House committees that drafted the American Health Care Act, as the Republicans call their measure, Mr. Upton said the latest version of the health care bill “torpedoes” protections for people with pre-existing medical conditions.
“I’m not at all comfortable with removing that protection,” Mr. Upton said of the pre-existing condition concession. Mr. Upton, who led the House Energy and Commerce Committee as the repeal movement built steam, declared on a local radio show, “I cannot support this bill with this provision in it,” just as Mr. Ryan was insisting that the legislation would protect the sick.
President Trump, whose advisers have been pressing aggressively for a vote on the health care overhaul, seemed oblivious to the latest setback for the measure on Tuesday. “How’s health care coming folks, how’s it doing — alright?” Mr. Trump said, addressing Republican lawmakers attending a trophy award ceremony in the White House Rose Garden for the United States Air Force Academy’s football team. “We’re moving along? It think it’s time now, right?” The loss of Mr. Upton, who has served in the House for 30 years, was a huge blow to Republicans, who had hoped to get the bill through the House by Thursday, before lawmakers go home again and face pressure from constituents. The Upton decision, which could give other Republicans cover to defect, came as party leaders faced an onslaught of advocacy groups saying the bill would harm the nation’s most vulnerable citizens — and as a late-night talk show host, Jimmy Kimmel, made an emotional appeal.
No response was audible from those in attendance, but the president addressed the rest of the crowd, adding, “They know it’s time.” A tearful Mr. Kimmel on Monday night told the story of his infant son, Billy, who was born with heart defects and had surgery. Mr. Kimmel pleaded with Congress not to undermine the Affordable Care Act’s ban on discrimination against people with pre-existing conditions.
Mr. Ryan insisted that Republicans were “making very good progress with our members,” but he offered no indication of when a vote might be held on the measure. Trump administration officials have said a vote could come as early as Wednesday, but as House Republican leaders scrambled to assemble a majority, a quick vote appeared unlikely. After Mr. Kimmel’s monologue went viral, former President Barack Obama weighed in on Twitter, writing: “Well said, Jimmy. That’s exactly why we fought so hard for the ACA, and why we need to protect it for kids like Billy.”
“There are a few layers of protections for pre-existing conditions in this bill,” Mr. Ryan said at a news conference. “What’s important is we want to have a situation where people can afford their health insurance. We want to have a situation where people have a choice of health insurers. That’s not happening in Obamacare.” House Republican leaders are also fighting against the clock. The House is scheduled to be in recess beginning on Friday and is not set to return until May 16. Republicans who are on the fence are likely to get an earful from their constituents.
Mr. Ryan and his fellow Republican leaders, under intense pressure from the White House, are struggling to round up the support for a revised version of their bill to repeal and replace President Barack Obama’s signature domestic achievement. “I think it’s imperative that we have a vote before we leave for a week,” said Representative Mark Meadows, Republican of North Carolina and the chairman of the conservative House Freedom Caucus.
After the failure of their earlier repeal bill in March, they have held off moving forward with a vote while they try to build support for the updated measure. In the radio interview, Mr. Upton was explicit: Concessions made to win over the hard-line members of the Freedom Caucus were costing the leadership support from more moderate Republicans. He said “there are a good number of us that have raised real red flags and concerns.”
At the heart of the debate is an amendment to the repeal bill proposed by Representative Tom MacArthur, Republican of New Jersey, with the blessing of House Republican leaders. Mr. Upton said he wanted to make sure that people with pre-existing illnesses like cancer or lupus are “not going to be discriminated against with a lot higher premiums.”
The amendment won over the hard-line House Freedom Caucus last week, in part by giving state governments the ability to apply for waivers from the existing law’s required “essential health benefits,” such as maternity, mental health and emergency care, and from rules that generally mandate the same rates for people of the same age, regardless of their medical conditions. Mr. Trump, whose advisers have been pressing aggressively for a vote on the health care overhaul, seemed oblivious of the latest setback for the measure on Tuesday.
The MacArthur amendment has given pause to numerous moderate Republicans, in large part because of concerns over whether it would allow states to gut those consumer protections. “How’s health care coming, folks, how’s it doing — all right?” Mr. Trump said, addressing Republican lawmakers attending a trophy award ceremony in the White House Rose Garden for the United States Air Force Academy’s football team. “We’re moving along? I think it’s time now, right?”
As Mr. Ryan was defending the plan, the Association of American Medical Colleges came out against it, joining the American Medical Association and a host of disease advocacy groups. Dr. Darrell G. Kirch, the president and chief executive of the medical colleges group, said the newest version of the repeal bill “dilutes protections for many Americans and would leave individuals with pre-existing conditions facing higher premiums and reduced access to vital care.” After visiting the Capitol on Monday, Vice President Mike Pence returned on Tuesday, trying to corral votes for the repeal bill. Mr. Ryan insisted that Republican leaders were “making very good progress with our members,” but he offered no indication of when a vote might be held.
Under the amendment, states could obtain a waiver from a provision of the Affordable Care Act that prohibits insurers from charging higher rates to people with pre-existing conditions. Republicans were clearly divided over the adequacy of the bill’s protections for people who are sick or disabled.
With a waiver, states could permit insurers to charge higher premiums based on the “health status” of a person who had experienced a gap in coverage. To qualify for a waiver, a state would have to have an alternative mechanism such as a high-risk pool or a reinsurance program to provide or subsidize coverage for people with serious illnesses. “There are a few layers of protections for pre-existing conditions in this bill,” Mr. Ryan said.
“States can’t leave people with pre-existing conditions high and dry,” Mr. MacArthur said Tuesday, defending his proposal. “They must have a risk pool, which would protect people from being priced out of the market.” At the heart of the debate is an amendment to the repeal bill proposed by Representative Tom MacArthur, Republican of New Jersey. The amendment, which won over the Freedom Caucus last week, would give state governments the ability to apply for waivers from the existing law’s required “essential health benefits,” such as maternity, mental health and emergency care, and from rules that generally mandate the same insurance rates for people of the same age, regardless of their medical conditions.
Mr. Ryan is struggling to win the public-relations battle over how his legislation would affect consumers. With a waiver, states could permit insurers to charge higher premiums based on the “health status” of a person who had experienced a gap in coverage. To qualify for a waiver, a state would have to have an alternative mechanism, like a high-risk pool or a reinsurance program, to provide or subsidize coverage for people with serious illnesses.
On his TV show Monday, Mr. Kimmel delivered a tearful opening monologue in which he revealed that his newborn son had been found to have severe heart defects, and he went on to talk about the issue of pre-existing conditions. “States can’t leave people with pre-existing conditions high and dry,” Mr. MacArthur said Tuesday, defending his proposal.
“Whatever your party, whatever you believe, whoever you support, we need to make sure that the people who are supposed to represent us, the people who are meeting about this right now in Washington, understand that very clearly: Let’s stop with the nonsense,” Mr. Kimmel said. “This isn’t football. There are no teams. We are the team, it’s the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to take care of each other.” But the MacArthur amendment has distressed some Republicans because of concerns that it would allow states to gut protections for consumers.
Both the Democratic Senatorial Campaign Committee and the Democratic super PAC American Bridge are running attack ads to undermine Republican support. Representative Tom Rooney, Republican of Florida, said he was “leaning yes” on the repeal bill, but agonizing over how to explain his vote to constituents.
“I have a lot of people who call my office on a daily basis who are extremely angry,” he said. “It’s not just because I’m a Republican, but because they are sincerely scared.”
Many people with pre-existing conditions fear that they may lose coverage and “are going to die because of a vote we might be taking,” Mr. Rooney said.
The Freedom Caucus had pushed hard to roll back federal insurance requirements.
“The pre-existing condition debate and discussion in Congress, far as I’m concerned, is over,” Representative Scott Perry, Republican of Pennsylvania and a member of the Freedom Caucus, said Tuesday. “They are covered; we acknowledge it; we provide for it; it is done.”
The White House threw a hand grenade into the delicate negotiations over health care on Tuesday when Mr. Trump’s budget director, Mick Mulvaney, suggested the administration might take action that would undermine the Affordable Care Act, with or without Congress.
Mr. Mulvaney raised doubts about whether the federal government would continue making certain payments to insurers. The payments enable insurers to reduce deductibles and other out-of-pocket costs for low-income people, a form of assistance known as cost-sharing reductions.
Discussing a bipartisan agreement in Congress to fund the federal government for the next five months, Mr. Mulvaney said, “There’s absolutely no language in this bill that requires us to make any Obamacare bailout payments, any C.S.R. payments of any way, shape or form as a result of this deal, O.K.?”
Asked whether the Trump administration would stop making the payments, he said, “We’ve not made any decisions at all on May.”
The White House Office of Management and Budget later said Mr. Mulvaney meant to say that the administration had made no commitment to pay the subsidies beyond May.
The House Democratic whip, Steny H. Hoyer of Maryland, said Mr. Mulvaney’s comments undermined confidence in insurance marketplaces and added of the Trump administration, “Its actions, continuing to sabotage the Affordable Care Act, will inevitably force premiums to skyrocket, hurting consumers.”
Congress’s inability to agree on health care legislation is already sending tremors through insurance markets, making it much more difficult for insurers to plan for 2018.
Monday was the deadline for insurers in California to file preliminary information on rates and benefits for next year. Dave Jones, the California insurance commissioner, said he had taken “the unprecedented step of authorizing health insurers to file more than one set of proposed rates for 2018 — one assuming the A.C.A. is enforced and funded, and the other assuming that President Trump and House Republican leaders continue to undermine or repeal the law and cause unnecessary premium increases.”
Even as some Republicans have come out in opposition to the repeal bill in recent days, the Trump administration and House Republican leaders have also picked up support from other party members.
Representative Paul Gosar, Republican of Arizona, said Tuesday that he had switched to yes after receiving assurances that the Senate would vote on one of his bills, which would scale back the federal antitrust exemption for health insurance companies.