BY ERIN MERSHON AND LINDSEY MCPHERSON
The House will vote Thursday afternoon on the Republican plan to overhaul the health care system.
“We will pass this bill. I feel great about the count,” said Majority Leader Kevin McCarthy of California after a Wednesday evening leadership meeting at the Capitol, confirming that he has 216 votes to pass the legislation. “As you know we’ve already debated a large portion of this, we’ll finish up the debate. . . . We’re going forward on the bill tomorrow.”
He estimated the vote on the bill (HR 1628) will take place around 12:30 or 1 p.m. Thursday.
The announcement puts the spotlight on Speaker Paul D. Ryan of Wisconsin and his conference, which has thus far struggled to build support for the package. In a catastrophic defeat in March for both Ryan and President Donald Trump, leaders abruptly pulled the first version of the measure from floor consideration when it became clear it lacked the support to pass.
Since then, members have negotiated a series of amendments, tacking on extra funding and other changes to mollify opponents and undecided lawmakers. Reps. Fred Upton of Michigan and Billy Long of Missouri secured an agreement that would add $8 billion over five years in funding to help some individuals with pre-existing conditions better afford higher premiums and out-of-pocket costs that would result from the GOP bill.
That followed an amendment from Rep. Tom MacArthur of New Jersey aimed at letting states get waivers from some of the 2010 health law’s insurance requirements, which brought on board a large group of hard-line conservatives in the House Freedom Caucus.
Before the Thursday vote on passage of the bill, those two amendments will be debated late Wednesday night by the Rules Committee, McCarthy said. That panel will consider a substitute amendment, those two amendments, and a third from GOP Reps. Gary Palmer of Alabama and David Schweikert of Arizona that was offered before the mid-April recess, according to one House source.
The House will also vote Thursday on a separate bill from Rep. Martha McSally, R-Ariz., that would ensure the package does not exempt members of Congress from the MacArthur amendment changes. That exemption was included to comply with the Senate’s rules of reconciliation, the process by which Republicans plan to move the bill.
Despite the scramble to persuade holdouts to support the package, it was not clear earlier Wednesday that leadership had convinced any of the opposed members, other than Upton and Long, to support the amendment. Earlier in the week, another 19 members had said they were firmly opposed to the legislation. At least 14 of them confirmed to CQ Roll Call on Wednesday that the Upton amendment had not changed their mind. GOP leaders can lose just 22 votes on the package and still pass the measure if there is full attendance.
The package itself is a hodgepodge of provisions that repeal and replace parts of the 2010 health care law. It would replace the law’s current tax credits with a skimpier package of credits that would be better for younger and wealthier Americans.
It would also make more than $880 billion worth of cuts to the Medicaid program over the next 10 years, among other changes. And it would make available some $115 billion for states, aimed at installing so-called high risk pools.
The GOP leaders’ late Wednesday announcement came after a flurry of activity on Capitol Hill. Vice President Mike Pence held a string of meetings with reluctant members, including Reps. Will Hurd of Texas and Thomas Massie of Kentucky. Top administration health officials, including Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Director Seema Verma, attended at least some of those meetings.
Across the hallway, Republicans on the Energy and Commerce Committee called an unexpected meeting to explain the amendment by Upton and Long, who both sit on that panel. They shared a two-page background document with lawmakers but not legislative text, according to one attending member.
The proposal by Upton and Long would provide an additional $8 billion over five years aimed at reducing health insurance premiums for some people in the states that choose to seek waivers from some of the law’s strict insurance requirements.
It is a response to criticism from a wide swath of moderate members who said the earlier amendment from MacArthur would have harmed individuals with pre-existing conditions. The MacArthur amendment would let states apply for waivers to let insurance companies charge sick people higher premiums if they went too long without insurance, as a way to bring down costs for healthier individuals.
The extra funding would come in the form of a targeted subsidy payment aimed at reducing premiums or out-of-pocket costs for those consumers only in states that sought a waiver, GOP aides said. It would be added to the $115 billion pool of money already included in the underlying bill for state initiatives, but would be directed toward that specific purpose, the aides said.
An analysis of the proposal from the progressive Center for American Progress, written before legislative text was released, suggested the funding would only help lower costs for about 76,000 Americans because of the funding levels.
Upton and Energy and Commerce Chairman Greg Walden of Oregon defended the amount in the proposal, saying they were confident only a few states would apply for the waivers, limiting the funds necessary.
“This seemed to be the logical amount based on past experience with coverage,” Walden said. “If you go way back, there weren’t that many states that created that many high-risk pools anyway, and remember, this is only the individual market. It’s a very narrow band here. But it’s an important group of people and we wanted to provide coverage for.”
Upton, too, said he thought at least some of his colleagues would come on board “now that we have this fix.”
“Yes, there will be, I think, a number of ‘no’ votes before, more than just [me and Long], that will be okay with this bill,” Upton said.
Democrats seemed primed to hang the vote on their GOP colleagues. “No number of amendments can fix this terrible bill — it is irredeemable. One in four Americans lives with a pre-existing condition and could effectively become uninsurable under this TrumpCare bill,” House Minority Whip Steny H. Hoyer said in a statement released shortly after the vote was scheduled.
Andrew Siddons, Joseph Williams and Kerry Young contributed to this report.