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Republican health bill gets crucial momentum with $8 billion deal

Thomas Kaplan and Robert Pear

WASHINGTON – Two Republican lawmakers who had come out against the House bill to repeal the health care law earlier this week reversed course on Wednesday and threw their support behind the plan after securing more money to help people with pre-existing medical conditions.

Reps. Fred Upton of Michigan, an influential voice in Republican health policy, and Billy Long of Missouri, a close ally of President Donald Trump's, told reporters after a meeting with Trump on Wednesday that the latest revisions had won them over. Those included $8 billion in additional funds over five years to supplement the insurance of people with pre-existing health problems.

Upton predicted the bill was "likely" to pass the House, a tremendous reversal of momentum for a measure that has twice been pulled back from a vote for lack of support.

Their announcement gave a big lift to Speaker Paul D. Ryan and other Republican leaders who are trying to round up enough votes to push the bill through the House this week. In an interview on a Wisconsin radio station on Wednesday morning, Ryan expressed confidence in the bill's chances.
"We've got some momentum," Ryan said.

Democrats, once confident of another collapse, tried to slow that momentum. The liberal health advocacy group Families USA said another $8 billion would do little to improve so-called high risk pools that would be set up by state governments to help insure people unable to afford insurance on the open market.

Sen. Chuck Schumer of New York, the Democratic leader, criticized that plan. "The proposed Upton amendment is like administering cough medicine to someone with stage four cancer," he said in a statement. "This Republican amendment leaves Americans with pre-existing conditions as vulnerable as they were before under this bill."

How far that $8 billion would go to ensuring that people with pre-existing medical conditions remain covered is not clear. The Upton amendment doesn't set down any rules for who states would make eligible for the pool, how much care would be covered, or how much individuals could be asked to spend on premiums.

The number of states that opt to create high-risk pools would also influence how far the $8 billion in additional funding would stretch. But a 2010 estimate made by conservative health economists at the American Enterprise Institute suggested that an adequate high-risk pool program for the country would cost between $15 billion and $20 billion a year. More liberal groups have estimated far larger numbers.

But with Upton and Long back on board, Republican leaders appeared ready to call another vote, after the collapse of their measure in March. Victory is far from assured. Another Republican from a Democratic-leaning district, Rep. Carlos Curbelo of Florida, seemed to indicate he was leaning against the American Health Care Act, as the Republican legislation is known, although he stood ready to be persuaded by Upton.

And pressure from health care providers, disease advocacy groups and others remains intense. The advocacy arm of the retirees' lobby AARP tweeted that the Upton amendment was an "$8 billion giveaway to insurance companies; won't help majority of those w/preexisting conditions. We remain opposed."

Rep. Nancy Pelosi of California, the House minority leader, said the money would be a small fraction of what is needed.
"It's time for the Republicans to abandon their moral monstrosity and pull this bill," she said.

If the effort fails, it will greatly weaken the president's hand on Capitol Hill and cast a shadow across the rest of his legislative agenda, especially the deep tax cuts and rewrite of the tax code that he has proposed – and promise to be no easier to tackle than health care.

Upton, the former chairman of one of the House committees that drafted the American Health Care Act, has a long history of negotiating with Democrats on health care measures, and his support could prove crucial.

He said on Tuesday that the latest version of the health care bill "torpedoes" protections for people with pre-existing medical conditions.

Trying to win their votes on the health bill, Trump met Wednesday with Upton and Long. Rep. Michael C. Burgess, R-Texas, and Rep. Greg Walden, R-Ore., the current chairman of the Energy and Commerce Committee who succeeded Upton as the head that powerful panel also attended the meeting. The dealmaking appears to have worked.

Last-minute spending increases and special provisions in 2009 and 2010 to win over Senate Democrats to the health care law had outraged some conservatives who fumed at "the Cornhusker kickback" and the "Louisiana Purchase." But so far, the Upton amendment has prompted no such anger on the Republican side.

Republican leaders now hope to get the bill through the House by Thursday, before lawmakers go home again and face pressure from constituents. Party leaders are facing an onslaught of advocacy groups and Democratic attack ads saying the bill would harm the nation's most vulnerable citizens.

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