No Obamacare repeal deal in sight, GOP to take flight

Posted at 5:09 PM, Apr 05, 2017

No deal on legislation to repeal and replace Obamacare is expected before lawmakers head home for a two-week break, putting a cap for now on the on-again, off-again talks that have divided the Republican party.

A senior administration source and two senior GOP congressional aides acknowledged that there's no agreement. And House lawmakers tell CNN they're not changing their travel plans and will leave Washington on Thursday. 

The effort to revive the health care bill that faltered late last month manifested itself in a series of closed-door meetings involving Vice President Mike Pence, White House officials and key GOP lawmakers. 


The overall dynamics, however, never changed.

Conservatives are set on their wish list and Republicans centrists have made clear those requests go too far. But the way lawmakers and the Trump White House have found themselves in the same exact box canyon they wallowed in as the initial iteration of "repeal and replace" imploded less than two weeks ago is illustrative of complexity that continues to dominate -- and plague -- this internal debate.

Asked for a status check in the wake of the more than two-hour Tuesday evening affair, one GOP official directly involved was blunt: "No closer to a final deal than we were 24 hours ago, and actually, quite possibly further away than we've ever been." 

What's driving the current impasse?


Conservatives in the House Freedom Caucus said Monday night they'd been told very specific things were placed on the table by Pence and Office of Management and Budget Director Mick Mulvaney: Giving states the option of applying for waivers to opt out of three central Obamacare requirements -- essential health benefits,community rating and guaranteed issue.

What does that mean? Well, these areas have been identified as crucial by conservatives to reaching their ultimate -- and repeatedly (and repeatedly and repeatedly) stated -- goal: lowering premiums. And that's likely true -- the essential health benefits provision forms the federal floor of what each insurance plan must contain. The guaranteed issue and community rating measures protect those with pre-existing conditions because they require insurers to sell policies to all enrollees, but bar them from charging higher prices to those with health conditions. Community rating also prevents insurers from charging women more.

The trade off in providing more robust coverage to individuals regardless of their health status is an increase in the cost of plans.

In a sense, these changes would directly undercut Republicans' promise to keep Obamacare's protections for those with pre-existing conditions. But conservatives counter that other provisions in the GOP plan, specifically high risk pools funded run by states but seeded with federal money, would essentially back fill the removal of those regulations, should states opt out.

But that's a very, very tough sell to the moderates in the conference, who, according to several who spoke privately with CNN, fear the fallout of including those three opt-out measures in any plan. While amenable to the idea of giving states the option of opting out of essential health benefits, how easily states obtain a waiver remains an open -- and exceedingly important -- question. 

On top of that, several sources involved in the process said moderates were caught off guard by the news that the other two regulations were on the table. 

What happened inside last night's meeting?

Talk. And lots of it. 

But there was limited, if any, progress on the thorniest issues: those regulations the White House is explicitly putting on the table in an effort to navigate a compromise.

Instead, the discussion settled primarily on the structure and purpose of state run high risk pools, and the possibility of sending more money in that direction via atop the currently allotted $115 billion for a state stability fund. House Energy and Commerce Committee staff briefed on the technical side of everything and circulated some of their own language. But the risk pools were always an accepted area of general agreement. 

Their inability to even substantively dig in on the key outstanding issues, at least in a way where they start chopping away at the areas of disagreement, "tells you all you need to know about this meeting," one participant said. 

What was the red flag that things weren't moving forward Tuesday night?

There was no legislative text put to the table by the White House. While House GOP staff brought, and circulated, technical language to try and bring members along, even those staffers appeared unclear about what was actually put on the table by the White House, according to one participant involved in the process. 

Freedom Caucus members insist they're open to the proposal put on the table by Pence and Mulvaney. But member after member from the group say the actual legislative language is crucial and no decisions will be made by the group until that has been put on the table. 

The absence of that language last night was identified as a red flag by participants in all sides of the debate -- and central to the roadblocks that still exist.

"I want to make sure I'm clear: there were no agreements tonight," Rep. Mark Meadows, the North Carolina Republican who chairs the Freedom Caucus, told reporters. "There was a general agreement that the progress we're making is really progress." 

What now?

More talk. And now, two weeks at home.

Lawmaker after lawmaker, seemingly in a coordinated fashion, emerged from the meeting after 10:30 p.m. ET Tuesday noting that "good progress" had been made. The same players are planning to meet again Wednesday in an effort to hash out agreement on the most difficult issues -- those insurance regulations. 

But early-week optimism that perhaps a path forward was clearing and, quite possibly, they were on their way to a House floor vote this week, has been decimated. Outside conservative groups, who have stuck firmly behind -- and helped drive -- the Freedom Caucus efforts were preparing to launch a broadside against the party's moderates on Wednesday for standing in the way of what they view as a clear compromise. 

Majority Leader Kevin McCarthy, R-California, made a surprise visit to the Tuesday meeting which otherwise boasted a grand total of zero participants that came from the party's leadership. But as he departed, he made clear that while lawmakers and the administration were still pushing forward on a bill, it would be "difficult to finish one by the end of the week." The House is currently scheduled to start its two-week Spring recess on Thursday afternoon. 

As one senior GOP aide involved in the first go-round of "repeal and replace" put it: "Welcome to reality."