Paul Ryan: Avoiding shutdown is GOP priority, not health care vote

Although it is possible that Congress might revisit the AHCA and this amendment as early as next week, the looming possibility of government shutdown next Friday will likely force them to first deal with a spending bill.

Trump administration officials, eager to score a win amid a rocky start to the president's term, have been pushing for a new vote.

During a White House news conference, USA president Donald Trump said progress was being made on a "great plan" for overhauling the nation's health care system, but provided no details.

"What we are focusing on is we have our list of priorities", including defense and border security, Office of Management and Budget Director Mick Mulvaney said this week. "I'd like to say next week, but ..." But more conservative members in the House refused to support it.

They cited the higher priority of passing a spending bill within days to avert a government shutdown, uncertainty over details of the developing health agreement and a need to sell it to politicians. Democratic negotiators are likely to resist providing the down payment that Mulvaney says Trump wants for construction of the wall, but the former GOP congressman from SC adds that "elections have consequences". Also, there's uncertainty over a developing deal to revive the Republican health bill.

Scott said repealing and replacing the law will make health care coverage more affordable. "We know there are a lot of people on the Hill, especially in the Democratic Party, who don't like the wall, but they lost the election. The reason why there's a chance for success right now is because of the fact that the chairman of the House Freedom Caucus Mark Meadows as well as the co-chairman of the Tuesday Group, Tom MacArthur, have gotten together".

"It is a reflection of how the conference is divided that we still don't have clarity and certainty on our work, and we will go back Tuesday and begin to have those frank discussions", a Republican member said.

The plan also doesn't address the concerns of moderates who are anxious about cuts to Medicaid and tax benefits that are too small to help people purchase individual coverage. States would be able to obtain waivers exempting them from the Essential Health Benefits standards.

No text has emerged, but an outline of his proposal said states could seek to relax essential benefits that Obamacare requires insurance plans to cover such as emergency room trips, maternity and newborn care, and mental health services. Per the compromise, moderate Republicans would agree to let states opt out of Obamacare's community rating provision, which would permit insurance companies to charge higher premiums to Americans with pre-existing conditions.

A Republican member familiar with the negotiations expressed some skepticism that the Freedom Caucus can actually deliver the votes they are promising. Community rating was meant to bring down costs for sicker members.

But the language may not be embraced by all of MacArthur's fellow House Republican centrists.

Nonetheless, April 29 will be the 100th day of Donald Trump's first presidential term and apparently it matters inside the White House.

During a conference call on Thursday with House Democrats, their leader, Nancy Pelosi urged them to remain united against the Republican legislation, according to an aide who was on the telephone call. At that time, the central components were not enough to convince the most conservative members to support it.

That was a major embarrassment to Mr Ryan and Mr Trump, and House leaders are loath to bring a revised health care bill on to the floor unless they are convinced it would pass.

In a speech in London on Wednesday, House Speaker Paul Ryan said that "health care is not dead".

"It's hard to do".

He added that "this is still a federal government structure, not totally happy with that outcome, but said "it at least cracks the door open to states having some ability to opt out of some of the insurance regulations".

  • Carolyn Briggs