White House pushes effort to revive sunken health care bill

A White House offensive to resurrect the moribund House Republican health care bill got an uneven reception Tuesday from GOP moderates and conservatives, leaving prospects shaky for the party's operation to salvage one of its leading priorities.

Vice President Mike Pence and other top administration officials were offering to let states request federal exemptions from insurance coverage requirements imposed by President Barack Obama's health care overhaul. Pence said he and President Donald Trump "remain confident that working with the Congress we will repeal and replace Obamacare," while White House spokesman Sean Spicer said Trump "would like to see this done," if possible.

"I'm not going to raise expectations, but I think that there are more and more people coming to the table with more and more ideas about how to grow that vote," Spicer said.

But there was no initial evidence that the proposal won over any of the GOP opponents that forced Trump and party leaders to beat an unceremonious retreat on their bill on March 24, when they canceled a House vote that was doomed to failure.

"We want to make sure that when we go, we have the votes to pass this bill," House Speaker Paul Ryan, R-Wis., told reporters. He said talks were in "the conceptual stage" and GOP lawmakers were close to consensus, but he declined to predict a vote before Congress leaves town shortly for a two-week recess — when lawmakers could face antagonistic grilling from voters at town hall meetings.

Under the White House proposal, states could apply for a federal waiver from a provision in Obama's statute obliging insurers to cover "essential health benefits," including mental health, maternity and substance abuse services. The current version of the GOP legislation would erase that coverage requirement but let states reimpose it on their own, language that is opposed by many moderates.

"The biggest change was putting the essential health benefits back in," said Rep. Chris Collins, R-N.Y., a leading moderate and Trump loyalist. He said that moved some moderates "to yes from no."

In addition, the White House would let states seek an exemption to the law's ban against insurers charging higher premiums for seriously ill people. Conservatives have argued that such restrictions inflate consumers' costs.

Reaction from rank-and-file GOP lawmakers was mixed, with conservatives and moderates alike saying they'd examine legislative language before deciding whether to accept the offer. Some weren't waiting, with moderate Rep. Frank LoBiondo, R-N.J., and conservative Rep. Mo Brooks, R-Ala., each saying they remained "no" votes.

Brooks said states should be allowed to opt out of Obama's insurance requirements without seeking federal permission to do so.

"It is wrong to require the states to come to Washington, D.C., on bended knee," Brooks said.

Rep. Jim Renacci, R-Ohio, was among several moderates warning that a quick vote would be counter-productive.

"If leadership hasn't learned the lessons of the failures of two weeks ago, then they'll bring something forward where nobody knows about it and try and get it passed," Renacci said.

Even so, some members of the House Freedom Caucus, the hard-right group whose opposition helped sink the Republican bill last month, were showing signs of accepting less than many originally wanted. The group's leader, Rep. Mark Meadows, R-N.C., said talks were boiling down to curbing several of Obama's coverage requirements — a far cry from the full repeal of the statute that many initially preferred.

"It perhaps is as much of a repeal as we can get done," Meadows told reporters. He added, "That's the calculation we have to make."

Similarly, some moderates whose opposition was also instrumental in the legislation's failure said they were cautiously optimistic the offer would produce results.

"We have to do things that will win people from both sides of the spectrum. Of course it's hard," said Rep. Tom MacArthur, R-N.J., a leader of the Tuesday Group of House GOP moderates.

The underlying House Republican bill would repeal much of Obama's 2010 law. It would erase its tax fines for consumers who don't buy policies, federal aid to help many afford coverage and Medicaid expansion for additional poor people.

Instead, substitute GOP tax subsidies would be less generous than Obama's for many lower earners and people in their 50s and 60s, the overall Medicaid program would be cut, tax boosts on higher earners would be ended and consumers who let coverage lapse would face 30 percent premium hikes.

Minnesota Human Services Commissioner Emily Piper thinks it's unlikely a new health care law will come out of Congress in the short term. Instead, Piper says she's watching for actions the Trump administration can take on its own.

"One is applying work requirements for people on Medicaid. That would limit access for people and I think it would also create a lot of churn on and off our program and create real administrative challenges for us as a state," Piper said.

Mark Zdechlik contributed reporting to this story.