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Wednesday 23 August 2017

White House pushes uncertain bid to revive health care bill

Donald Trump said progress was being made on health care reform
Donald Trump said progress was being made on health care reform

The White House has expressed confidence that a breakthrough on the troubled Republican health care bill can be achieved in Congress next week.

But house of Representatives Republican leaders, burned by a March debacle on the measure, were dubious and signs were scant that an emerging plan was gaining enough votes to succeed.

During a White House news conference, US president Donald Trump said progress was being made on a "great plan" for overhauling the nation's health care system, but provided no details.

"We have a good chance of getting it soon," he said. "I'd like to say next week."

The White House optimism is driven largely by a deal brokered by leaders of the conservative Freedom Caucus and the moderate Tuesday Group aimed at giving states more flexibility to pull out of "Obamacare" provisions.

A senior White House official acknowledged that it was unclear how many votes Republicans had, but said House speaker Paul Ryan had told the White House that a vote could come together quickly.

But Republican politicians and aides to party leaders, conservatives and moderates alike, were sceptical that the House would vote next week on the health legislation.

They cited the higher priority of passing a spending bill within days to avert a government shutdown, uncertainty over details of the developing health agreement and a need to sell it to politicians.

Mr Trump said he planned to get "both" a health care deal and a spending bill.

Many Republicans also expressed doubts that the health care compromise would win over enough members to put the bill over the top, especially among moderates.

The bill would repeal Barack Obama's health care law and replace it with less generous subsidies and eased insurance requirements.

"Every time they move the scrimmage line, you risk losing other people who were 'Yes' but this changes them to a 'No'," congressman Dan Donovan said of attempts to win over one end of the party spectrum without losing votes from the other side.

The Staten Island centrist said he remained a No vote, partly because the legislation would increase Medicaid costs for New York City's five boroughs.

An outline of a deal has been crafted by Mark Meadows of North Carolina, who heads the hardline Freedom Caucus, and New Jersey's Tom MacArthur, a Tuesday Group leader.

US vice president Mike Pence also played a role in shaping that plan, Republicans say.

It would deliver a win to moderates by amending the Republican bill to restore Mr Obama's requirement that insurers cover specified services like maternity care.

But in a bid for conservative support, states would be allowed to obtain federal waivers to abandon that obligation.

In addition, states could obtain waivers to an Obama ban on insurers charging sick customers higher premiums than consumers who are healthy - a change critics argue would make insurance unaffordable for many.

To get those waivers, states would need to have high-risk pools - government-backed insurance for the most seriously ill people, a mechanism that has often failed for lack of sufficient financing.

"It looks to me like we're headed in the right direction," Dave Brat, a Freedom Caucus member, said.

He said that assuming the outline is translated into legislative text he backs and is added to the health care bill, he would now support the legislation and believes most of Freedom Caucus' three dozen members would also back it.

The Tuesday Group has about 50 members and does not necessarily vote as a bloc, and it is unclear how many colleagues Mr MacArthur would bring with him to such an agreement.

The White House is anxious to pass legislation quickly, partly because Mr Trump will probably hit his 100th day in office without a having signed a major piece of legislation.

In an interview, budget chief Mick Mulvaney said he was surprised at "the toxicity levels" that have divided the party over health care and hoped members' two-week break would prove "healing".

But House Republican leaders face the same problem that has plagued them for seven years of trying to concoct a plan for repealing Mr Obama's 2010 law: the party's conservatives and moderates are at odds over how to do it.

With Democrats solidly opposed, Republicans can lose no more than 21 House votes to prevail, and Mr Ryan short-circuited a planned vote last month because more than that would have defected.

That was a major embarrassment to Mr Ryan and Mr Trump, and House leaders are loath to bring a revised health care bill on to the floor unless they are convinced it would pass.

Mr Ryan sent a mixed message about the bill's prospects in remarks on Wednesday to reporters in London.

"It's difficult to do. We're very close," he said, adding: "It's just going to take us a little time."

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