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Republicans turn to risk-sharing measure to resuscitate ACA repeal bill

Eager to show constituents back home the effort to repeal and replace the Affordable Care Act was not dead, Republicans added a new amendment to the American Health Care Act on April 6 just before leaving for their two-week congressional spring recess.

The measure, which was introduced by Reps. Gary Palmer of Alabama and David Schweikert of Arizona and adopted in a 9-2 vote by the House Rules Committee, would create what the authors called an "invisible risk-sharing program" aimed at helping states reduce premiums by reimbursing health insurers for high-cost individuals.

Palmer and Schweikert are calling for a $15 billion fund to be set up for the program, which they said was modeled after a high-risk pool approach no longer used in Maine.

No vetting

But Rep. Jim McGovern, D-Mass., the acting ranking member on the House Rules Committee, said the Palmer-Schweikert amendment would do nothing to prevent the expected loss of healthcare coverage for 24 million Americans by 2026 under the Republican bill.

"It's nothing more than lipstick on a pig," he said during the Rules Committee meeting, where the amendment, which had been unveiled only an hour earlier, was added to the ACA repeal bill.

Rep. Alcee Hastings, D-Fla., said he was concerned the Palmer-Schweikert amendment did not specify the diseases that would be covered under the risk-sharing program and that it would be left to Health and Human Services Secretary Tom Price to negotiate with states what pre-existing conditions would be excluded, making it possible Americans with asthma, arthritis, cardiovascular disease and other chronic conditions would be left paying large out-of-pocket costs.

McGovern said the amendment had been hastily written by a "couple of good old boys with a typewriter" in a "backroom," and had not been properly vetted. "You just don't want to go home for recess without being able to claim a win," he added.

Rep. Pete Sessions, R-Texas, chairman of the Rules Committee, acknowledged as much, saying the amendment would give Republicans an opportunity to "amplify" why it was necessary to revive the AHCA, which Speaker Paul Ryan, R-Wis., had pulled from the House floor March 24 after not being able to gather enough votes from his own party to pass it.

"Members can go back home and say, 'Thank you for the feedback,'" Sessions said.

But at least one Republican, Rep. Louie Gohmert of Texas, objected to the Palmer-Schweikert amendment, saying: "I don't think the best solution to federal power is more federal power."

Republicans embrace

Ryan, however, said the measure was being "embraced by a broad spectrum" of Republicans. "This brings us closer to the final agreement we all want to achieve," he said during his weekly news conference just before the Rules Committee voted on the amendment.

Rep. Mark Meadows, chairman of the House Freedom Caucus — a group of some of the most conservative Republicans on Capitol Hill — said his group backed the amendment, declaring the measure would "make sure premiums don't skyrocket for those that are sick."

"It is a step in the right direction, but certainly not the final step," Meadows said during an April 6 Washington panel discussion, hosted by Politico and the Peter G. Peterson Foundation.

It was the Freedom Caucus and a cadre of moderate Republicans, known as the Tuesday Group, who derailed Ryan's initial attempt to get the ACA repeal bill through the House in March.

After the defeat, President Donald Trump and Ryan both said they were moving on to other tasks on their agenda, like tax reform. But within days, they were talking about reviving their bill and started a series of closed-door discussions on Capitol Hill and at the White House.

More work remains

During Ryan's news conference, House Majority Leader Kevin McCarthy, R-Calif., however, acknowledged that "more work remains" before all members of the party are on board with the AHCA.

The No. 1 goal for the Freedom Caucus is lowering premiums, Meadows said, adding that his group would not settle for any legislation that would not achieve that objective.

"If we don't do that, we have failed," he said during the Politico event.

The Freedom Caucus has also demanded Republicans drop the ACA's essential health benefits — the 10 statutorily required general categories of care — and the ACA's community ratings, which forbid insurers from charging people with illnesses higher amounts for their coverage.