Moderate Republicans facing pressure to get in line on Obamacare repeal

WASHINGTON — Moderate House Republicans are now facing pressure to support legislation to repeal and replace Obamacare after the previously shelved bill this week was given a new life — and new language that satisfied restive conservatives.

The new language was negotiated between Freedom Caucus Chairman Mark Meadows, R-N.C., and Rep. Tom MacArthur, R-N.J., co-chairman of the moderate Tuesday Group. The language was intended to bring on board the conservative Freedom Caucus members — who had rejected the repeal bill in March because they said it did not go far enough in repealing Obamacare mandates — without alienating moderates concerned that their constituents would lose coverage.

The new amendment preserves some of the popular mandates of Obamacare such as requiring that insurers cover maternity care and emergency room visits. But it also allows states to apply to waive those requirements. States will be approved for the waiver if they can prove doing so would reduce premiums, increase the number of people who receive coverage, stabilize the market or increase competition.

The hardline House Freedom Caucus announced Wednesday that at least 80% of its members would support the legislation after a new amendment. The group has roughly three dozen members and had previously held out votes.

Read more:

Freedom Caucus backs Obamacare repeal bill with new changes

Freedom Caucus leader Brat predicts health care passage within weeks

Rep. Mark Meadows banking his constituents' faith will extend to him

The infusion of Freedom Caucus support didn’t immediately give Republicans the number of votes they needed to pass the repeal bill, but it did pull them toward the finish line. By backing the new amendment, the hardline group was able to alleviate the pressure they had been facing for working to sink the bill, and attention shifted to moderates whose support is now crucial. With no Democratic support, the bill will fail if two dozen Republicans vote "no."

"If the Freedom Caucus votes for it, yes it does” put the pressure on moderates, said Rep. Frank LoBiondo, R-N.J. LoBiondo said he’s still a “no” on the bill because “the issues that were critically important to me the first time around — Medicaid, pre-existing conditions, covering seniors, making sure nobody falls through the cracks — as far as I can tell have not been addressed."

“Tom MacArthur is the leading moderate in Congress, it’s his amendment,” House Speaker Paul Ryan, R-Wis., said to reporters Thursday when asked whether moderates should support the bill. “Tom MacArthur, who actually has an entire career working in insurance, understanding the math and mechanics and science of insurance, has come up with a very innovative amendment that we think works really well.”

Ryan dismissed the idea that moderate lawmakers could be at risk in the next election cycle if they vote for the legislation. Instead he said GOP seats would be up for grabs if Republicans didn’t keep their promise to repeal Obamacare.

“If you violate your promise, if you commit hypocrisy in politics, that’s the risk to a person’s seat,” he said. But despite the push, Ryan said he has not scheduled a vote and will not until House leadership is confident they have enough votes for the bill to pass.

“There’s frustration that we are here where we are because of the Freedom Caucus stand three weeks ago and now the hot potato has moved to those of us that are typically the ones who cast the tough votes all the time,” Rep. Chris Collins, R-N.Y., told reporters.

Collins, who is a Tuesday Group member, has always backed the legislation. He said he understood why his colleagues were upset with the turn of events but people needed to “get over the hurdle to say ‘this is too important.' ”

As of Thursday, it was unclear how many holdouts there would be for the legislation, but many of MacArthur’s Tuesday Group colleagues were against the bill, including co-chairman Charlie Dent, R-Pa., and Reps. Dan Donovan, R-N.Y., and Leonard Lance, R-N.J.

“I’m trying to figure out how this makes the legislation better and I will tell you, at this stage, I’m having a hard time finding how it makes it better,” Rep. Mario Diaz Balart, R-Fla., told reporters. He said he “eventually got to a yes” on the last version of the bill, but with this new legislation he was back to square one as undecided.

In an attempt to keep or gain moderate support, the amendment requires that insurance companies not charge higher premiums based on gender and offer coverage to people with pre-existing conditions. But it does not say that people with pre-existing conditions can’t be charged more. The legislation does provide money for high-risk pools to help lower costs for people with pre-existing conditions, but that system has had mixed success nationwide and requires significant amounts of money to work.

Ryan insisted Thursday that the infusion of federal funds into the pools would make them successful.

“People will be better off with pre-existing conditions on our plan," Ryan said.

Democrats were unconvinced.

“I say to the more moderate Republicans in the House, if you didn’t like the first version you sure shouldn’t like this version, and, frankly you’ll pay a huge consequence in the 2018 elections if you vote for it,” Senate Minority Leader Chuck Schumer, D-N.Y., said on the Senate floor Thursday. “Even if passed the House, the chances for survival in the Senate are small.”

The Senate is a more moderate body, and the legislation is expected to face significant changes if it makes it past the House.

Larry Sabato, director of the University of Virginia Center for Politics, agreed that moderates will likely face consequences in 2018 related to the Obamacare repeal. But, he said, they likely will be damaged no matter how they vote.

“I don’t think (supporting the bill or not) much matters because as we found out with Obamacare, Democrats who voted for it and who voted against it, were all punished,” Sabato said. “The Blue Dogs were punished to a greater extent than the liberals because they had more vulnerable districts.” Blue Dog Democrats are the more moderate faction of the party.

“It really doesn’t matter. The average voter is going to look at this and if it’s not done, blame Republicans. And they may blame Republicans if it is done,” Sabato said. He cited UVA Center for Politics study of Trump voters that found one in four Trump voters (26%) said "they or their families would be hurt" if Obamacare were repealed.

Contributing: Herb Jackson