Republicans inched closer to securing enough votes to pass their legislation to replace the Affordable Care Act Wednesday, but Democrats warned that they will face political consequences for weakening protections for patients with preexisting conditions.
Two prominent House GOP members who had said earlier this week that they would oppose the latest iteration of the American Health Care Act announced after meeting with President Donald Trump Wednesday that they would now support the bill.
An apparent deciding factor for Reps. Fred Upton, R-Mich., and Billy Long, R-Mo., was a new amendment that provides $8 billion more over five years for coverage of patients with preexisting conditions. Other holdouts have signaled openness to voting for the bill since the amendment was added as well.
The White House is pressuring the House to hold a vote before the end of the week, possibly as early as Thursday. There are still about 20 Republicans who have publicly said they will vote against it and others are still up in the air.
Rep. Steve Chabot, R-Ohio, said Upton and Long flipping on the bill was a “good sign,” but the effort to whip up 216 votes in favor of the AHCA continues.
“We don’t have those yet,” he said. “We’re hoping maybe we’ll have them by tomorrow.”
The biggest sticking points for GOP moderates so far have been provisions that enable states to opt out of some ACA protections and guarantees, including the assurance that patients with preexisting conditions could not be discriminated against. Some have also expressed concern about the scaling back of the Medicaid expansion.
Republicans maintain that waivers can only be granted if a state meets certain requirements, including establishing a high-risk pool for sicker patients. Chabot argued the ACA forces healthier patients to overpay by putting everyone in the same system.
“What we’re trying to do is have equity and fairness here,” he said. “Preexisting conditions will be covered.”
However, Democrats insist high-risk pools have failed to rein in costs for those with serious medical conditions in the past, and they say the federal funds Republicans are offering to bolster those plans are not nearly enough to keep coverage affordable.
According to Rep. David Cicilline, D-R.I., Democrats readily acknowledge the ACA is flawed and they have always been open to working with Republicans to improve it. They see the AHCA as a step backward, though, leaving 24 million fewer patients insured according to the Congressional Budget Office in order to give a massive tax cut to the wealthy.
“If they do this, they’re going to do real harm to millions of Americans,” he said.
Cicilline dismissed the GOP’s urgency to push a bill through the House as an effort to set up even more tax cuts for the rich under Trump’s tax reform plan.
“It’s really a tax cut bill disguised as a health care bill,” he said.
Rep. Dina Titus, D-Nev., said Republicans keep weakening protections for patients on Medicaid or suffering from preexisting conditions, despite their claims to the contrary.
“The more they try to fix it, the worse it gets,” she said.
Rep. Lois Frankel, D-Fla., called the preexisting condition coverage “the crown jewel of the Affordable Care Act.” Voting to repeal that provision will be “the kiss of death” for Republican lawmakers.
According to Rep. Markwayne Mullin, R-Okla., those alleging that the latest version of the AHCA endangers those with preexisting condition do not understand the bill.
“People with preexisting conditions are still going to have the opportunity to be covered,” he said, though he acknowledged that states would have the choice to opt out of the ACA’s requirements if they provide coverage through the high-risk pools.
Rep. Gerry Connolly, D-Va., said that such pools are not a sufficient substitute for a statutory guarantee of coverage.
“The current version before the Republican caucus would in fact gut the protection on preexisting conditions,” he said.
However, he said hesitant Republicans might see the new amendment as “a fig leaf” of political cover to throw their support behind the bill.
Rep. Darin LaHood, R-Ill., said he is “open-minded” about the legislation, but he insisted that those with preexisting conditions must remain protected while also cutting health care costs and offering patients more options.
“I think we have to start down this road of fixing heath care,” he said.
LaHood admitted that getting a bill to the president’s desk is still a steep climb, even for a party with a majority in both chambers of Congress.
“We’re going to have to have the fortitude, we’re going to have to work together to get that done,” he said.