WASHINGTON– There are plenty of Republicans across Capitol Hill that see the GOP plans to repeal and replace the Affordable Care Act as a settled issue at least for the moment, but behind the scenes several key players are not letting the issue go..
An impasse between conservatives and moderate Republicans last month led House Speaker Paul Ryan to pull the bill and tell his fellow members that GOP leaders were “moving on” with their agenda.
Since then, there’s been a small but growing and steady stream of indicators that if nothing else, Republicans — from President Donald Trump, new golfing partner Sen. Rand Paul and several freshmen congressmen — are still looking for a deal.
And Monday night, Vice President Mike Pence spoke to the House Freedom Caucus — the group of conservatives that helped sink the health care bill last month.
Here’s the latest state of play of health care efforts on the Hill:
What are the changes being discussed?
Conversations on a pathway forward have continued to pick up over the last week, and they have focused almost entirely on picking up members of the House Freedom Caucus — the chamber’s most conservative wing of the GOP.
The two key issues: repeal of Essential Health Benefits and repeal of the existing community ratings provision.
A straight repeal of those two items remains an almost impossible sell to the broader conference (the moderate Tuesday Group was fleeing in large numbers when EHBs was put on the table two weeks ago), so they’re trying to figure out a way to massage it in a way to appease both poles of the conference.
One idea being kicked around is to provide more authority to the Health and Human Services secretary to give states the ability to make these changes on their own.
After meeting Pence, Freedom Caucus Chairman Mark Meadows said his group was “intrigued” by the idea of giving give states more flexibility to opt out of Obamacare regulations using a waiver process, but Meadows wouldn’t promise the Freedom Caucus would be on board in the end.
“No one made any definitive changes in terms of moving from ‘no’ to ‘yes’ primarily because there is not enough detail to do so,” Meadows said. “But I can tell you all the ‘no’s,’ every one of the ‘no’s,’ expressed a willingness to look at this in a very detailed manner.”
Paul, who has urged the Freedom Caucus to hold together in opposition to the original bill, said after a meeting with members of the group Monday that they still weren’t zeroing in on a final deal. He said that the insurance regulations, known in shorthand as “Title One” regulations after their place in the Affordable Care Act, remain the problem they have been to compromise for weeks, labeling them as “a big sticking point.”
“I think there still is an opportunity for compromise on this, but I think it still needs more time,” Paul told reporters outside of his office.
Where is the White House?
The White House blitz right now is real, and it is clearly taking the lead on the effort.
Pence has taken and increasingly large role in the process, according to several lawmakers and aides involved in the process. That is being received well for the moment — and the efforts are growing.
Pence met with several moderate members at the White House on Monday and then swung by the Freedom Caucus later on. Why?
“It appears the White House has realized President Trump doesn’t like losing,” was the way one GOP aide characterized the clear shift in position.
It was only 11 days ago, as everything collapsed around them, that the President instructed his team — and House leaders — to drop the issue entirely and move on to tax reform.
Those instructions are now being viewed as premature by everyone involved, but the core issues — and central problems that plagued and eventually sank the original bill — remain unchanged.
Is there a deadline?
There remains significant skepticism about whether something can come of the talks among top GOP aides — or what kind of timeline any deal would work under.
House Ways and Means Chairman Kevin Brady, one of the authors of the health care bill, has made clear that his committee has moved onto tax reform, as was requested by the President and announced by Ryan the day health care collapsed.
But Brady did tell reporters Monday his team is serving to “monitor and assist” any ongoing talks and has been asked to help on both policy and technical questions.
That said, Brady noted that one of the lessons learned from the first pass at health care “was not to rush through” the process and instead focus on a timetable driven by the organic nature of the talks.
Have Republican leaders learned anything from the first bill’s failure?
One thing that has become increasingly clear in the wake of the health care collapse is rank-and-file members are in large part desperate to find a way to get the conference to “yes.”
It’s a moment sparked in part by political panic that has risen over the course of the last 10 days.
Ryan has urged these talks along, and has stayed tangentially involved via texts and calls over the past two weekends, but he and his leadership team aren’t taking an active role in spurring them along, according to multiple GOP aides.
Leadership officials are wary of timelines and, perhaps more importantly, don’t want to be accused again of circumventing the process and forcing something through. That gives their members space to figure something out, but at least for the time being, it has also removed some of the biggest and most important players in the room.
Are moderates on board?
There is still zero indication any of the players currently talking have figured out a new way to thread the needle between the conservative and more centrist factions of the conference.
While Pence has gotten heavily involved behind the scenes, the vice president’s initial meeting Monday with a small group of moderate members today was the first sign that anyone from the White House has started to approach the work of assuaging the concerns of the equally skittish moderates inside the conference.
This group has not only felt outside of the process, but has spent much of the past two weeks ripping the Freedom Caucus at every opportunity.
The two sides are not in a good place — at all. The moderates in the conference were barely on board for Ryan’s initial bill. Any changes that move the bill further to the right from there is viewed by Ryan’s team as almost certainly to only alienate them further.
In short, this gets real when the moderates say it’s real. Until then, Freedom Caucus members negotiating among themselves does not a deal make.
Anyone who has covered Congress long enough can tell you that things rise from the dead quite often, particularly when there’s a political reason to apply the electric paddles to the dead body.
But Moderates have put the onus on the Freedom Caucus, White House and leadership to address their concerns and to this point, and by all accounts it’s too early in the process to identify whether the effort will end with something that will really, actually, finally bring this back into the land of the living.
