The latest version of the proposal would maintain popular benefits in former President Barack Obama’s signature domestic achievement, such as preserving the ban on insurers rejecting customers with pre-existing medical conditions.
WASHINGTON — White House officials, desperate to demonstrate progress on President Donald Trump’s promise to repeal the Affordable Care Act, are pushing to resurrect a Republican health-care bill before his 100th day in office next week.
Some members of the president’s team have grown consumed by that deadline, worrying that appraisals of the president’s tenure will be brutal and hoping that a last push on health care might bring a measure of salvation.
But Congress usually cannot take on two big things at once. At the same moment Trump hits his 100th day April 29, Republican congressional leaders face a far more urgent deadline: Much of the federal government will run out of money.
Reaching agreement to keep the government open past midnight that Friday will be the first priority of Republican leaders when Congress returns Monday from a two-week recess.
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“I believe that when we first go back, that’s going to be the thing we’ll address immediately and have to get done by Friday,” said Rep. Dan Donovan, R-N.Y.
The president has not laid down a hard deadline on the health-care bill. “We have a good chance of getting it soon,” Trump said at a news conference Thursday. “I’d like to say next week, but it will be — I believe we will get it. And whether it’s next week or shortly thereafter.”
Republican leaders and the White House have been searching for a health-care agreement that could placate enough moderates and hard-line conservatives to win passage in the House.
The latest version of the proposal, published Thursday morning by Politico, would maintain popular benefits in former President Barack Obama’s signature domestic achievement, such as guaranteed coverage for emergency services and maternity care. It would also preserve the health law’s ban on insurers rejecting customers with pre-existing medical conditions.
But under this Affordable Care Act replacement, states could seek waivers from many of those mandates if they demonstrate that premiums would be lowered, the number of insured people would increase or “the public interest of the state” would be advanced.
States could request an exemption from the rule intended to ensure that people with pre-existing conditions could not be charged prohibitive premiums, but only if those states establish a high-risk insurance pool.
“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. Asked if a health bill could pass as Congress tries to avert a government shutdown, the president said, “I think we’ll get both.”
The complications that remain in the bill are likely to be far too difficult to finesse at the same time the House and Senate press to pass a giant spending bill. Tussles over the spending deadline — including possible debates over top administration priorities such as a border wall and money for immigration-enforcement officers — are expected to consume the Capitol.
And Democrats — whose votes will be needed to keep the government open — will have their own demands, most important billions of dollars to lower out-of-pocket spending for low-income Americans purchasing health coverage on the Affordable Care Act’s online marketplaces.
Senior Republicans appear unconvinced a revised health-care bill would ensure passage in the House. Donovan, an opponent of the original Republican health-care bill, said the proposed amendment “really doesn’t address the concerns that I had.”
Rep. Charlie Dent, R-Pa., a leader of the moderate House Tuesday Group, said it “does nothing to change my views.” He lamented any focus “on an arbitrary 100-day deadline.”
The changes — proposed by Rep. Tom MacArthur, R-N.J., co-chairman of the Tuesday Group — come as Republicans face anger from supporters over their failure to act on long-standing campaign pledges, and from defenders of the Affordable Care Act.
A conference call for House Republicans had already been scheduled for Saturday, before lawmakers’ return to Washington next week.
This month, Vice President Mike Pence and other Trump administration officials sought a new agreement with the conservative House Freedom Caucus, whose opposition helped fell the first bill. The measure, which gained little traction, earned a nickname on Capitol Hill: Zombie Trumpcare.
Regardless of the bill’s fate, lawmakers are approaching a critical moment on health care. Insurers and business groups are pressing hard for Republicans and Trump to maintain health-insurance subsidies before insurers’ decisions in the coming weeks on whether to keep offerings on the Affordable Care Act’s marketplaces and how much to charge for them.
Without those “cost-sharing reductions,” insurers warn that they will have to sharply raise prices or leave the markets.
About 7 million people now qualify for the subsidies. At stake is roughly $10 billion in payments expected to be made to the insurers next year. Some House Republicans oppose how the Obama administration funded them, and they won a court case potentially blocking the funding that is now on appeal.
This week, insurance executives met with Medicare officials to plead their case. They left that meeting with Seema Verma, the new Medicare head, with no promises. Trump has publicly toyed with the idea of withholding the subsidies as a way to force Democrats to negotiate over the House proposal, and Verma told the insurers they should look to Congress to appropriate the money.
State insurance regulators with the National Association of Insurance Commissioners sent a letter to Congress on Wednesday, pleading, “Your action is critical to the viability and stability of the individual health insurance markets in a significant number of states across the country.”
Insurers must begin the process of filing rates in the coming weeks, said David Dillon, a fellow at the Society of Actuaries, who has been working with state regulators and insurers about how to price plans in the marketplace. Insurers say their rates could rise as much as 30 percent.
Insurers remained largely silent on the proposed amendment, which seemed to revive a discussion of how to handle the sickest and most costly individuals by allowing states to set up high-risk pools.
Separating off these individuals causes the cost of coverage for everyone else to go down, making it a potentially popular idea, said Stephen Zuckerman, a co-director of the Health Policy Center at the Urban Institute. But these pools have traditionally been poorly funded, leaving many people with potentially expensive pre-existing medical conditions without affordable coverage, if they can buy a plan at all.