Pulse Check: Can The GOP Health Care Bill Be Saved?

Enlarge this image toggle caption Timothy D. Easley/AP Timothy D. Easley/AP

President Trump may have said he is ready to move on, but the House Freedom Caucus can't let health care go.

The same firebrand conservatives who helped derail the GOP's long-awaited legislation to repeal and replace key parts of the Affordable Care Act are now trying to breathe new life into the bill with a long shot effort to bring it back for a vote in May.

Or at least keep it on life support through the two-week April recess when they'll otherwise have to explain the bill's derailment back home. "We're on the eve of going home and spending two weeks with our constituents ... and they know they're going to get questions about this," said Rep. Steve Womack, R-Ark. "And for the people who were 'no' they'll have justification to deal with."

Womack, who was a "yes" on the GOP's American Health Care Act, said despite encouraging talk from some corners of the House, a revival was not in sight.

"I did not get the message from our conference this morning that we're nearing the finish on health care," he said. "It's obvious those negotiations continue to take place — and there might be some movement in some areas that give leadership some hope we can get closer to the finish line — but I'm not suggesting at all that we are right there and this thing could change on a dime."

The 30-some members of the conservative House Freedom Caucus, led by Rep. Mark Meadows, R-N.C., are in active talks with the administration — in the aftermath of a skirmish between some of the group's members and Trump over the failure of the health care bill. Those talks are being led by Vice President Pence, who spent Monday and Tuesday in the Capitol huddling with different factions of House Republicans.

According to lawmakers and aides briefed on the negotiations, conservatives are talking with the White House about tweaking AHCA to allow states to seek waivers of Obamacare's requirements for "essential health benefits," or basic health care services all insurance plans must offer, as well as restrictions on "community ratings," or how much insurers can charge for premiums based on age and gender.

Originally, conservatives wanted to repeal those aspects of the law entirely to allow for health plans with lower premiums. Now there are talks about keeping them in place but allowing states to appeal to the Department of Health and Human Services to waive them on a state-by-state basis.

It's far less than conservatives had hoped for in negotiations. "It perhaps is as much of a repeal as we can get done," conceded Meadows, according to the Associated Press. "That's the calculation we have to make."

The talks have not so far publicly brought on board any of the moderate Republicans who already opposed rolling back essential health benefits or who worry that doing so would raise costs on people with pre-existing conditions. The talks also ignore the fact that many of the GOP's "no" votes were based on the legislation's sweeping changes to how Medicaid is funded, and the current negotiations don't address those concerns at all.

It's also unclear that including the updated proposal into the bill would even secure the votes of enough House Freedom Caucus members to pass it. Rep. Mo Brooks, R-Ala., is still a "no" and said his colleagues should not expect the conservative faction to vote as a bloc.

"For some reason, some in the media think that we vote lockstep with each other. That is categorically not the case. If you were to think of us more as an intellectual conservative think tank with a backbone, that's what we are," Brooks told reporters.

House Speaker Paul Ryan, R-Wis., spoke cautiously of the effort, describing talks as in "the conceptual stage" and saying that any action before the April recess was highly unlikely. "We want to make sure that when we go, we have the votes to pass this bill," he said.

White House spokesman Sean Spicer was similarly cautious. "I'm not going to raise expectations, but I think that there are more and more people coming to the table with more and more ideas about how to grow that vote."

The House is operating under a tight timeline. Republicans on all sides of this debate agree that May is a make-or-break deadline for the bill because of budgetary constraints. The health care bill is moving under a process protected by this year's budget resolution. Once Congress begins moving on next year's resolution, the budget protections for their health care bill expire.

Even if the House can muscle up the votes to revive the bill next month, it still must clear the Senate, which is expected to make significant changes to the House bill, and then the House would have to pass it again.

Politically, most Republicans say they do not want to drag out the health care debate longer than they have to if it's clear it can't pass. The only thing worse than failing once to deliver on a central campaign promise is failing twice.

"Let me just tell you what we can't do — we can't try again and fail," Womack said. "So there will not be a try-again effort unless it is certain that we have the votes to pass it."