House Speaker Paul Ryan speaking to reporters during a news conference on Capitol Hill last month. (Photo: Manuel Balce Ceneta/AP)

WASHINGTON — House Speaker Paul Ryan and his deputies attempted to rebrand the party’s troubled health care plan as providing “layers of protection” for people with preexisting conditions, even as members of their caucus continued to defect from backing the legislation.

Ryan told reporters Tuesday morning. “[T]he purpose of our bill is to get more choices, lower prices while preserving the protections for preexisting conditions.”

Republic Rep. Steve Scalise of Louisiana, the majority whip, read aloud a letter from a constituent with a preexisting condition who said Obamacare did not help him. “Our bill protects people with preexisting conditions and actually provides multiple layers of protection for people with preexisting conditions in ways that Obamacare doesn’t do,” Scalise said.

Ryan later released a long fact sheet claiming the waiver process for states is “strict” and that the bill still protects sick people.

VERIFIED: MacArthur Amendment strengthens AHCA, protects people with pre-existing conditions. https://t.co/6W7bDEO40r — Paul Ryan (@SpeakerRyan) May 2, 2017





The new focus on preexisting conditions comes after President Trump told CBS over the weekend that the bill “guarantees” coverage for those with preexisting conditions and is still changing. “Preexisting conditions are in the bill,” he said. “And I mandate it.” The White House has pushed for another vote on Obamacare repeal and replacement this week, before the House leaves for recess.

But some Republicans are refusing to back the new bill precisely because it does not protect people with preexisting conditions as robustly as the current law. The bill was altered from the version that was introduced in March (and later withdrawn) by allowing governors to seek waivers to let insurers opt out of providing some essential benefits and also to charge people with preexisting conditions more for their coverage. The change was intended to win backing from the conservative Freedom Caucus, most of whose members support the new version, which requires governors to create a high-risk pool where people with preexisting conditions could purchase insurance. But that insurance could be unaffordable for many, according to health care experts.

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GOP leadership assured those in the meeting that people with preexisting conditions would be adequately covered, according to lawmakers, because governors would do the right thing. “The bottom line is, we trust the states and the federal government as a backup,” said Rep. Steve Chabot of Ohio.

But that’s not enough for a growing number of GOP lawmakers who have come out against the plan and kept Ryan tantalizingly short of the votes he needs to pass a bill to repeal and replace Obamacare. Ryan can only afford to lose about 22 Republicans and still pass the bill, which no Democrats are backing.

“I’ve supported the practice of not allowing preexisting illnesses of being discriminated against from the very get-go,” Rep. Fred Upton, R-Mich., told WHTC News Tuesday morning. “This amendment torpedoes that and I’ve told the leadership I cannot support this bill with this provision in it.”

Though the GOP leadership is insisting those with preexisting conditions will be covered under its bill, some individual lawmakers are telegraphing a different message. Rep. Mo Brooks, R-Ala., a member of the Freedom Caucus, told CNN Monday that the provision will allow those who have lived “good lives” to pay less for health care, by taking unhealthy people out of the insurance pool. “They’ve done the things to keep their bodies healthy, and right now, those are the people who have done things the right way, who are seeing their costs skyrocketing,” Brooks said.

Upton said some lawmakers are urging Republicans to vote for the measure in the hopes that the more moderate Senate will fix it and send back a bill that does guarantee coverage for people with preexisting conditions. But any such move would likely quickly lose members of the Freedom Caucus.

Rep. Dave Brat, R-Va., said the Senate better not change the bill at all or risk losing his support. “It’s about time they get a dose of medicine,” Brat said. “They better not change it one iota.”

Rep. Mark Meadows, R-N.C., head of the Freedom Caucus, said any changes to the bill to appeal to moderates risks losing more votes on the conservative side. “At this point, you have to figure out if you’re going to gain or lose votes based on that,” he aid. “It’d be a hard calculation right now.”

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