GOP lawmakers in the House have taken the crucial step of putting their latest hope for a health care compromise on paper, circulating legislative text that could launch yet another round of health care talks just in time for the last of President Donald Trump's first 100 days in office.
A draft amendment obtained by CNN, first reported by Politico
, gives renewed insight into where the GOP may be moving next. The amendment would allow states to seek waivers to weaken several key Obamacare insurance reforms that protect those with pre-existing conditions
, including the benefits insurers must cover in their policies and the ban on allowing carriers to charge more based on a person's health background.
The amendment is an effort to once again try and bridge the gap between hardline conservatives in the House Freedom Caucus
and more moderate Republican members -- a divide so wide that that when the compromise first emerged last week GOP aides remained skeptical that it would be enough to get leadership to the 216 votes it needs to pass the bill.
The amendment was negotiated between Tuesday Group leader Tom MacArthur, a New Jersey Republican, and House Freedom Caucus Chairman Mark Meadows, with consultation from the White House and House leadership. But there is still little proof that the amendment will finally be the breakthrough that gets the health care bill passed in the House.
The politics haven't shifted
The math problem House leadership has always had remains the same. Any changes aimed at garnering support of conservative House Freedom Caucus members could deter moderates from the bill.
"We still don't know how this amendment changes the net vote total," a senior GOP aide told CNN. "The only 'deal' that matters is the one that gets us 216 votes."
Leaving the Capitol Tuesday night, Meadows told reporters that he was still working with his group to garner support for the amendment.
"We're evaluating this amendment and we're looking to debate this as a caucus before we make a final decision," Meadows said.
Members in the dark
Many members coming back into town Tuesday night knew little about the proposed amendment except for what they'd seen in news reports. Rep. Lou Barletta, a Pennsylvania Republican who'd been supportive of House leadership's bill before, described the process as "very frustrating."
"All I've seen is what I've read in the paper," Barletta said. "Nobody should take any vote for granted."
Rep. Mike Coffman, a Republican from a swing district in Colorado, said he'd been supportive of leadership's first bill, but without seeing the amendment, which had not yet been leaked widely to the media, he said he didn't know where he stood on it.
"It's a change," Coffman said. "I think certainly for the Freedom Caucus people, it moves them closer, but for somebody like me, it doesn't."
What's in the amendment
The amendment would also allow insurers to charge enrollees in their 50s and early 60s more than younger ones.
States that requested these waivers would be required to put in place protections to minimize cost increases for those with pre-existing conditions, such as high risk pools.
Obamacare's "essential health benefits
" provision requires insurers to provide 10 services, including maternity coverage, substance abuse and prescription drugs, in all plans. And its community rating measure prevents insurers from charging more to people based on health history or gender.
The health reform law also limited insurers from charging older enrollees more than three times younger ones. The original GOP repeal bill would have widened that ratio to five-to-one. This provision prompted a lot of backlash from moderates and advocacy groups, such as the powerful AARP.
While MacArthur stressed that states would not be allowed to waive the Obamacare rule that requires insurers to cover those with pre-existing conditions, health policy experts say the amendment would greatly affect those who are sick or have had medical issues in the past. It would allow insurers to charge them more for coverage, and also it would let insurers once again offer skimpy policies. That would make it harder for the sick to find comprehensive policies that cover their treatments.
Obamacare's protections for those with pre-existing conditions are among the law's most popular provisions.