Republicans optimistic of Obamacare repeal

Republicans are increasingly optimistic they will schedule — and win — a vote in the House this week to repeal Obamacare.

President Trump’s chief of staff, Reince Priebus, and his chief economic adviser, Gary Cohn, predicted Monday the bill would hit the House floor before lawmakers leave town late Thursday for a weeklong recess.

Mr. Cohn said they already have enough support to win the vote, but White House press secretary Sean Spicer reeled in expectations, saying they’re getting “closer and closer every day” but are “not there yet.”

“We feel confident in the direction that this is going,” he said.

House GOP leaders hadn’t scheduled anything as of late Monday, as centrists continued to balk at changes designed to lure in conservative holdouts.

Mr. Trump also injected new confusion into the debate, suggesting he might change the bill to shore up protections for people who are already sick, though he may have been referring to Senate action later on.

“I want it to be good for sick people. It’s not in its final form right now,” he told Bloomberg News. “It will be every bit as good on pre-existing conditions as Obamacare.”

Vice President Mike Pence said Monday the bipartisan budget deal announced a day earlier is also a good sign for the Trump administration’s entire agenda, including the president’s effort to repeal Obamacare.

“The learning process for many on Capitol Hill about governing has been moving forward,” he said in a morning interview on CBS.

House GOP leaders have inched toward victory via changes that would allow states to opt out of parts of Obamacare requiring insurers to cover “essential” benefits such as maternity and mental health care or prescription drugs.

States can also waive rules requiring insurers to charge healthy consumers the same amount as sicker consumers, so long as states set up risk pools to subsidize those priced out of the market.

The changes won over the 30-plus-member House Freedom Caucus, but some centrists said the tweaks broke their pledge to protect people with preexisting conditions from market discrimination.

Rep. Billy Long, Missouri Republican, cited that concern in announcing his opposition to the bill on Monday.

Other Republicans, exhausted by the protracted debate, say they need to act before they lose momentum from the changes. Leaving town without a repeal vote could allow opposition to harden when GOP holdouts face angry voters back home.

“The longer they wait, the harder it will become to pull the legislative trigger. If they are within earshot of 216 House votes, they remain in town to get it done,” GOP strategist Ford O’Connell said. “For moderate House Republicans in particular, what is tough is they are being asked to trust the legislative process at a time when the 2018 electoral landscape is giving them heartburn. And this is what is driving most of the holdup.”

Obamacare’s defenders steeled themselves for a goal-line stand this week, saying the debate was at a critical juncture.

Topher Spiro, a vice president for health policy at the Center for American Progress, urged social media followers over the weekend to hit GOP moderates with a “tidal wave” of calls against the bill on Monday, saying it was the only way to thwart the effort.

The American Heart Association, the lobbying arm of the American Cancer Society and eight other patient groups piled on pressure Monday, saying the latest tweaks would harm people with chronic conditions.

“Weakening these rules would enable insurers to charge higher prices to people with pre-existing conditions, possibly making insurance unaffordable for those who need it most,” the groups said in a joint statement.

The GOP bill offers $115 billion in federal “stability” funding over 10 years for the pools and an additional $15 billion for a risk-sharing mechanism to backstop sicker consumers who could be priced out of the market.

Policy analysts and advocates said that might not be sufficient, however, and that high-risk pools haven’t worked well in the past.

“Offering these risk sharing mechanisms as an alternative to affordable health insurance is not a viable option, particularly high-risk pools,” the patient groups wrote. “Previous state high risk pools resulted in higher premiums, long waiting lists and inadequate coverage.”