Nicole Gaudiano

USA TODAY

WASHINGTON — House Speaker Paul Ryan announced a Republican agreement Thursday on legislative language that he said will bring the chamber closer to passing a bill to repeal and replace the Affordable Care Act.

Ryan, after canceling a vote on repeal legislation that divided his caucus last month, said the House will add language to the draft bill to create a new federal risk-sharing program that he said would lower premiums and add protections for people facing challenges getting access to affordable care.

The $15 billion proposal for a Federal Invisible Risk Sharing Program, as described in a memo from House Majority Leader Kevin McCarthy, R-Calif., is designed to help states reduce premiums by reimbursing health insurance issuers for high-cost individuals — those with significant health problems — beginning in 2018.

The proposal by Reps. Gary Palmer of Alabama and David Schweikert of Arizona -- both members of the conservative Freedom Caucus -- is modeled after a program in Maine, and Ryan said it brings House Republicans closer to a final agreement on how to repeal and replace Obamacare.

“This promise is just too important and the consequences of inaction are too dire for American families for us to give up,” Ryan said.

Ryan said the amendment makes the American Health Care Act a better bill and the caucus is still working on other consensus ideas.

The divide between the Freedom Caucus members and the more moderate wing of House Republicans is “narrowing quickly,” he said. Many Freedom Caucus members refused to support the earlier version of the bill, and efforts to add language to woo them led Republican moderates to turn against the bill as well.

Democrats have pushed for increasing reimbursements to insurance companies for high claims under the Affordable Care Act as a way to entice insurers into the individual market and bring down costs.

But House Minority Leader Nancy Pelosi, during a Thursday news conference, said the new Republican proposal only puts a "Band-Aid on that horrible, monstrous bill."

"They are desperate to keep Trumpcare alive, continuing their campaign to raise massive costs on seniors and hard-working families," the California Democrat said.

It’s unclear how the Republican plan will handle protections for those with pre-existing conditions. The Affordable Care Act mandates that insurers provide coverage regardless of a person's medical history. The Freedom Caucus has called for amendments that would allow states to opt out of those requirements, among other things. Ryan didn’t rule out the proposal when asked about it during his news conference.

“I'm not going to get into the particular details of the conversations that are going on,” he said. “But we believe that there are additional reforms and ideas that can do both things, protect people with pre-existing conditions and continue to lower premiums and give states flexibility so that more insurers can come into the marketplace.”

Republicans are looking for proposals that will bring more insurers into the marketplace, he said.

“We are all dedicating to making sure that people with preexisting conditions still get the kind of coverage that they need and that's affordable coverage,” he said. “And we want to find a way to do that in such a way that everyone else who's in the insurance market can also get lower premiums, affordable choices, and more choice — more competition.”

Rep. Tom MacArthur of New Jersey, a co-chair of the moderate Tuesday Group, called the proposal a “substantive idea,” and said it will help ensure those with serious illnesses aren’t suddenly treated differently from everyone else.

The former insurance executive said the only difference under the proposal for those with high claims is that the federal government would be paying their claims behind the scenes, and receiving 90 percent of their premiums. By pulling those high-risk individuals out of the normal insurance pool, he said everyone else’s rates will go down.

“It offers real care to people that have the misfortune of getting sick, they're not suddenly treated differently than everyone else,” he said. “It doesn't fix everything. But it's a good idea that will help people and then more broadly help everyone else's premiums.”

Protection for pre-existing conditions, he said, is a separate discussion from this risk-sharing proposal.

“This idea just creates a fund for people that are high-risk to help them continue to be able to buy insurance affordably and allow everyone else to not have their premiums go up,” he said.

Read more:

Mike Pence and House Republicans scramble to resurrect Obamacare repeal

Speaker Paul Ryan says Republicans' Obamacare repeal may take months

Even with the new language, it is unclear when Republicans might be in position to bring the bill to the floor. Ryan said negotiations are ongoing within the Republican caucus. The House is scheduled to be out of session for the next two weeks, but McCarthy didn't rule out calling the House back into session.

"Should we be prepared to advance our bill through the House in the coming two weeks, we will advise Members immediately and give you sufficient time to return to Washington," he wrote in his memo to GOP members.

Palmer said the risk-sharing arrangement would be a federal program for three years and then the states would be able to take it over. The program has reduced premiums in Maine and increased the number of insured, he said.

"I think that we're going to see premiums coming down I think perhaps by next year," Palmer said.

Schweikert said the idea resulted from discussion among members from different districts who wanted to lower premiums for people in the individual health care market. The proposal is designed to address the need for people with chronic conditions to stay in the health care system while mitigating some of the "extraordinary costs" transferred to others trying to buy insurance.

"This doesn't close this chapter, but I think it gets us close," he said.

Contributing: Herb Jackson, The Record.