WASHINGTON — House Republicans snagged a few more votes for their Obamacare repeal-and-replace bill after promising to plump it up with an $8 billion amendment designed to help those with pre-existing conditions pay for their health care — part of a high-stakes push to win over moderate GOP lawmakers who have balked at the legislation even as the White House ramps up pressure for a vote on the bill this week.
"I support the bill with this amendment," said Rep. Fred Upton, R-Mich., said after meeting with President Trump at the White House on Wednesday morning. Upton is an influential player on health care policy, and he had previously opposed the bill amid concerns it would undermine protections for people with pre-existing conditions.
Another holdout, Rep. Billy Long, R-Mo., also switched from a "no" to a "yes" after meeting with Trump. He said his GOP colleagues "sold" him on the amendment.
The biggest sticking point so far: the provision in Obamacare that bars insurance companies from discriminating against those with pre-existing conditions. The current GOP bill would dramatically undermine that, by allowing insurance companies charge people with pre-existing conditions —anything from cancer to pregnancy — higher premiums than other consumers.
That change prompted Upton's push to add the extra $8 billion to GOP legislation, a pot of money to help sicker patients pay their premiums and other health care bills. Upton is the former chairman of the House Energy and Commerce Committee, which has played a central role in drafting the GOP bill.
With Democrats unified against the measure, GOP leaders can only lose about 22 Republicans and still pass the bill. By multiple news outlets’ counts, roughly 20 lawmakers said they’d vote “no” on the legislation as of Tuesday afternoon and about two dozen others remained undecided.
With the new money, Republicans expressed confidence that they could win passage of the health care bill, although it was unclear whether the additional funds would cause hard-line conservatives to back away from their support. The bill has been a tug-of-war between the moderate and conservative factions inside the House Republican Conference during weeks of intense negotiations and embarrassing setbacks.
House Speaker Paul Ryan, R-Wis., said Wednesday morning that no decision has been made yet on whether there will be a vote this week. He said the GOP was getting "real close" to an agreement
House Majority Whip Steve Scalise, R-La., echoed that in an interview with Fox News on Wednesday. “We're moving closer to getting the number we get to pass the bill, and that magic number is 216, and that's what we've been focused on from the beginning."
Critics said the Upton provision was still woefully inadequate to protect those with pre-existing conditions, and they noted that the Congressional Budget Office estimated an earlier version of the legislation would cause 24 million people to either forgo or lose their health insurance.
“Despite today’s wheeling and dealing, the GOP repeal bill still drops the coverage guarantee for people with pre-existing conditions, strips coverage from millions, and drives up costs for millions more," said Frederick Isasi, executive director of Families USA, a liberal-leaning health advocacy group. "A measly $8 billion handout isn’t going to change that."
The GOP bill would repeal major elements of the 2010 Affordable Care Act and allow states to opt out of other provisions, including several popular consumer protections. For example, states could seek a waiver from existing requirements that insurers must cover maternity care, substance abuse, and other key health services.
States can also seek an exemption of the pre-existing condition protections, allowing insurers charge such patients more if the state has created a high-risk pool. Such risk-sharing programs are intended to help lower patient costs, but they have had mixed results in the past.