The White House and House Republicans appear short of a last-ditch deal on their long-promised repeal of Barack Obama’s health care law. And in an unexpected twist, “Obamacare’’ — never very popular — seems to be rising in public opinion polls.
“There’s no suggestion we should be changing our flights,’’ moderate Rep. Chris Collins, R-N.Y., said Wednesday afternoon, a day before lawmakers were slated to leave Washington for their two-week recess. “We’re going home … without a deal.’’
From the party’s right flank, Freedom Caucus member Rep. Mark Sanford of South Carolina said: “I’ve heard nothing of substance at this point that would break the logjam.’’
The Thursday schedule from House Majority Leader Kevin McCarthy, R-Calif., delivered the hard truth — no health bill vote.
Two weeks ago, House Speaker Paul Ryan, R-Wis., was forced to call off a floor vote on a GOP measure to repeal much of the Obama-era Affordable Care Act, or ACA. The GOP legislation replacing it would have scaled back the federal role in health care, covering 24 million fewer people over time, while also cutting taxes for upper-income earners.
Then as now, deep differences among hardliners and moderates impeded the Republican march. Each side blames the other. The congressional recess could drain more momentum from the repeal drive although many Republicans say individually they’re not giving up.
Obamacare more popular
Meanwhile, weeks of truth-or-consequences debate on Capitol Hill may be shifting public attitudes on the ACA, which has remained divisive since Democrats passed it in 2010 without any Republican support.
Gallup said this week that the law gained majority approval for the first time, with 55 percent supporting it and 41 percent disapproving. It was the first majority for “Obamacare’’ since Gallup started asking the question in the same format in November 2012. It marked a major shift from five months ago when 42 percent approved and 53 percent disapproved.
Another nonpartisan survey by the Kaiser Family Foundation found relief that Congress has not managed to repeal the health law. It showed that 3 in 4 Americans want the Trump administration to make the law work. About 2 in 3 said they were glad the House GOP bill didn’t pass. But people split evenly between wanting to keep or repeal the statute.
Unwelcome fallout from translating the GOP vision into practical policy seems to be contributing to the party’s difficulty selling its plans.
For example, experts said the latest idea floated this week would raise premiums for people with medical problems.
Chipping away at requirements
Roughed out in negotiations between the White House and leaders of the conservative Freedom Caucus, the idea would allow states to seek waivers of two ACA requirements. One, known as community rating, forbids insurers from charging higher premiums on account of people’s medical problems or pre-existing conditions. The other is the essential health benefits provision that spells out categories of benefits all insurance plans must cover.
Conservatives who want the federal government out of health care argue that those provisions have driven up premiums and decreased choice. The idea is to put states back in charge of insurance rules, reasoning that that would increase the availability of plans with lower premiums, attractive to younger, healthier customers.
But health care industry consultant Robert Laszewski said it would also open a “back door’’ to a system where the sick can get priced out of coverage.
“It’s hard for me to believe that any state would take us back … when it comes to the protections that consumers have for pre-existing conditions,’’ Laszewski said. “There is no doubt that Obamacare as a system is not working very well, but nobody wants to go backward.’’
Pool for high risk
Republicans say their bill includes a fallback option for people with health problems. It would create a $100 billion fund that states can use for a variety of purposes, including high-risk insurance pools where people with medical problems can get coverage.
But Trish Riley, executive director of the National Academy for State Health Policy, said those didn’t work well in the past. Patients tended to be very sick, and premiums were often too expensive.
“There would be real challenges for people with illnesses to get affordable coverage,’’ Riley said. “You will get guaranteed access to coverage, but you won’t be able to afford it.’’ Her nonpartisan organization offers policy advice to states.
Trump administration officials and leading GOP legislators said they are not giving up trying to find common ground between conservatives and moderates. Ryan and McCarthy met with Pence at the White House Wednesday night to discuss their next steps on health care, an aide to Ryan said. They also talked briefly with President Donald Trump.
Democrats were dismissive.
“It’s as if the president and Paul Ryan went to some of the Republicans and the Freedom Caucus and said, ‘We can make this worse,’’’ Rep. Jan Schakowsky of Illinois said.