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 House Republicans Still Looking for Votes to Pass ACA Repeal and Replace

House Republican leaders do not have the votes to pass their Affordable Care Act (ACA) “repeal and replace” bill, the American Health Care Act, and will have to wait at least one more week or longer to try to get legislation on the House floor for a vote.
This development comes despite House Speaker Paul Ryan (R-Wis.) winning some conservative House Freedom Caucus converts to the bill earlier this week with the so-called McArthur Amendment, which would allow states to seek waivers to relax the ACA’s mandate to cover pre-existing conditions and essential health benefits, like maternity care and prescription drugs.
Matthew Fielder, a fellow at the Brookings Institution, this week published new analysis that said the McArthur Amendment, named after Rep. Tom McArthur (R-N.J.), would charge sick people much more for coverage and deplete the insurance risk pool of healthy people.
“The framework created by the waiver would allow states to effectively eliminate community rating protections for all people seeking individual market coverage, including people who had maintained continuous coverage,” he said.
The intent of the amendment is to drive down the cost of health insurance, a priority for conservatives, despite objections by many moderate Republicans in the Tuesday Group who will not vote for a weakening of the pre-existing condition language in the ACA.
Democrats remain en bloc against the Ryan bill, the other name for the ACA repeal and replace effort, declaring it an attempt to gut health coverage for millions of Americans and leave many who remain covered with “skinny” health plans that lack the essential health benefits prescribed by the ACA.  
Experts watching the developments tell Provider there is no certainty the continuing struggle among conservative and moderate factions of the majority party will end any time soon, and certainly Republicans missed the chance to pass a bill during the first 100 days of the Trump administration, which ends April 29.
“They can have a fine bill, if they just did not need 216 votes [the number of lawmakers needed to pass a bill in the House],” joked Tom Miller, resident fellow at the American Enterprise Institute, who said it is clear Republicans want to avoid a repeat of March 24 when Ryan had to pull repeal and replace legislation for lack of support from within his own party.
Miller said the clock continues to tick on health care, and even if the House were to get something approved in the next week or two, there are “landmines” waiting in the Senate. There, moderates will likely want to scrap the most conservative elements of a House bill and revisit the bill’s revamp of the Medicaid funding system, which the Ryan bill would move to a per capita cap and block grant mechanism from the current open-ended funding approach in the federal-state program.
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