WASHINGTON — Republicans are working overnight on a deadline deal to save their Obamacare replacement bill, which seemed doomed just hours earlier.
The White House and Republican leadership are making an 11th hour pitch to win over hardline conservative opponents of the American Health Care Act. For the first time since the bill was unveiled, its passage through the House seems within reach.
"I don't want to be so optimistic to say that the deal is done, but I do think that there is a framework to work with," House Freedom Caucus Chair Mark Meadows, who has been a major opponent of the bill, said Wednesday evening.
In the afternoon Meadows and other members of the far-right group had dug in and declared the whole process needed to go back to the drawing board. Hours later they had a very different tone, though they stressed no deal was done.
The pitch from leadership appears to center around repealing the essential health benefits included in Obamacare. These benefits mandate things that insurance companies must cover in all plans including maternity care, hospitalization, mental health services, addiction treatment, and vaccinations for children.
Also being discussed are "Title I" rules, which include major insurance industry regulations such as the ban on denying coverage to people with pre-existing conditions.
Conservatives are pushing for a full repeal of Obamacare regulations, arguing it is the only way to bring down the price of insurance premiums. Meadows said that there is no deal in place, but he is optimistic one could be reached before the AHCA goes to its final vote in the House Thursday.
"We're encouraged tonight based on the real willingness of not only the White House but our leadership to make this bill better," Meadows said Wednesday evening.
"We're not there yet, but we're very optimistic that if we work around the clock between now and noon tomorrow that we're going to be able to hopefully find some common ground," he said.
It would be a near-miraculous coup for Speaker Paul Ryan, Republican leadership and the White House, who had struggled to craft and sell a bill that moderates and hardliners could agree on. This week has seen an aggressive push by the White House to get a deal done. The president even called Mark Meadows in the middle of the Wednesday evening Freedom Caucus meeting, Meadows said.
For Democrats, the changes being discussed amount to a worst-case scenario. Democratic Rep. Frank Pallone said the removal of essential health benefits would bring back the days of skeletal plans where people don't truly have health insurance.
"You had people who had plans that didn't cover hospitalization. What's the point of even having an insurance policy that doesn't cover hospitalization?" Pallone said. "Now you'll be able to sell insurance policies that are essentially meaningless. So it's just another nail in the coffin of what we tried to achieve."
Even if a deal is reached with the Freedom Caucus, removing essential health benefits could alienate too many moderate Republicans in the House or Senate.
Senate Republicans are already using the budget reconciliation process to pass the AHCA with just 51 votes rather than the usual 60 for legislation. That process comes with limits on what can and cannot be included.
In the views of many — including Senate Minority Leader Chuck Schumer — removing essential health benefits is outside the bounds of the reconciliation process, which must be focused on budgetary issues. That decision will be made by the parliamentarian, the non-partisan referee in the Senate.
However, Republicans could overrule the parliamentarian and allow repeal to be included. It would be a major break from tradition, but it is within the rules. Republicans haven't explicitly said they're ready to take that road but Sen. Ted Cruz is already openly advocating for it.
Meadows said he has been in touch with Senate Republicans. When told that Sen. Schumer believes repealing health benefits will not be allowed, he responded "last time I checked Mr. Schumer's not sitting in the chair to provide that particular verdict."
Paul McLeod is a politics reporter for BuzzFeed News and is based in Washington, DC.
Contact Paul McLeod at email@example.com.
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