WASHINGTON — White House officials, desperate to demonstrate progress on President Trump’s promise to repeal the Affordable Care Act, are pushing to resurrect a revamped version of a Republican health care bill before his 100th day in office next week.
Some members of the president’s team have grown consumed by the marker, worrying that public appraisals at this traditional evaluation period will be brutal and hoping that a last push might bring a measure of salvation.
But at the same moment Trump’s hundred-day mark is reached on April 29, there is a far more urgent deadline: Much of the federal government will run out of money. Reaching agreement on a measure to keep the government open past midnight that Friday will be the first priority of Republican leaders when Congress returns Monday from a two-week spring recess.
“I believe that when we first go back, that’s going to be the thing we’ll address immediately and have to get done by Friday,” said Representative Dan Donovan, a New York Republican.
GOP leaders and the White House have been searching for a health care compromise that could placate enough moderates and hard-line conservatives to win passage in the House.
The latest version of the proposal, published Thursday morning in Politico, would maintain popular benefits in President Barack Obama’s signature domestic achievement, such as guaranteed coverage for emergency services and maternity care. It would also preserve the health law’s ban on insurers rejecting customers with pre-existing medical conditions.
But under the compromise Affordable Care Act replacement, states could seek waivers from many of those mandates if they could demonstrate that premiums would be lowered. States could request an exemption from the existing health law’s “community rating” rule intended to ensure that people with preexisting conditions could not be charged prohibitive premiums — but only if those states establish a high-risk insurance pool where such consumers could purchase government-subsidized insurance.
But the complications that remain may be far too difficult to finesse at the same time the House and Senate press to pass a giant spending bill.
Tussles over the spending deadline — including possible debates over top administration priorities such as a border wall and money for immigration enforcement officers — are expected to consume the Capitol. And Democrats — whose votes will be needed to keep the government open — will have their own demands, most importantly billions of dollars in subsidies for health insurance companies to lower deductibles and other forms of spending for low-income Americans purchasing health coverage on the Affordable Care Act’s online marketplaces.
Senior Republicans appear unconvinced that a revised health care bill would ensure passage in the House. Donovan, an opponent of the original Republican health care bill, said the proposed amendment “really doesn’t address the concerns that I had.” He has cited reservations over how the legislation affects seniors and provisions that would particularly disadvantage New York City.
“We’re in the midst of negotiating sort of finishing touches,” Speaker Paul Ryan, a Wisconsin Republican, said this week while leading a congressional delegation in London.
He added: “It’s difficult to do. We’re very close. It’s basically, make good on the promises that were made.”
But the legislation’s future is unclear. For now, the proposal exists only in vague talking points. West Wing advisers to Trump are decidedly mixed in their views of how aggressively to raise expectations. The aide feeling perhaps the most pressure, according to people close to the discussions, is the chief of staff, Reince Priebus, who was blamed internally for the botched vote count around the first repeal effort and is closest to Ryan within Trump’s circle.
The initial bill’s failure has left lawmakers wary of artificial deadlines. Its inability to garner enough support last month to be brought for a vote in the House was an embarrassing setback for Trump, Ryan, and the Republican conference.
In recent weeks, the insurance companies have been strongly urging the Trump administration and Congress to commit to funding cost-sharing reductions, warning that without the money from the government, the companies will have to sharply raise the prices of their plans offered through the state marketplaces. Some insurers have hinted they will leave the markets altogether without the funding.
About 7 million people now qualify for the subsidies, which reduce the amount someone has to pay in deductibles and copayments when they buy a plan. At stake is roughly $10 billion in payments expected to be made to the insurers this year. Some House Republicans oppose how the Obama administration funded them, and they won a court case potentially blocking the funding that is now on appeal. The next court date is May 22.