(Bloomberg) — House Republicans plan to vote Thursday on their long-stalled Obamacare repeal measure, setting up a high-stakes test given the continuing doubts about whether they have enough votes to guarantee passage.
"We’re going to pass it," House Majority Leader Kevin McCarthy told reporters Wednesday evening, adding that "we have enough votes."
The decision comes after several weeks of agonizing over how Republicans would deliver on seven years of promises to repeal Obamacare, as well as intense pressure from the White House to hold the vote. Even so, a number of GOP moderates remain opposed or undecided, adding significant suspense to the Thursday vote.
A key momentum shift came Wednesday morning, when Rep. Fred Upton reversed his earlier opposition and embraced the bill after a meeting with President Donald Trump. He told reporters that he would vote for the measure once a new amendment he helped devise is added that would boost funding for people with pre-existing conditions.
"I think it is likely now to pass in the House," Upton said at the White House.
It remains unclear whether Upton’s reversal swayed many other holdouts. A White House official Wednesday night said they had at least 218 votes, which would be enough to ensure passage.
Several moderates, including Reps. Charlie Dent of Pennsylvania, Leonard Lance of New Jersey and Ileana Ros-Lehtinen of Florida, said Wednesday they remain opposed even with the latest changes.
"I’m still a no," Lance said, adding that Upton’s amendment isn’t enough to resolve his concerns about coverage for people with pre-existing conditions.
Upton’s amendment, which he said would be posted later Wednesday, would provide $8 billion over five years to reduce premiums and other costs for those with pre-existing conditions who have a gap in coverage and reside in states that received waivers from some of Obamacare’s requirements under another provision in the bill.
Representative Walter Jones of North Carolina said he remains opposed to the bill, and that some Republicans were talking privately about how little money was actually being added under Upton’s amendment.
‘Hard to believe’
He said one colleague told him he finds "it hard to believe members would change their vote for $8 billion."
Jones said he talked to his state’s insurance commissioner, who gave him an estimate of up to 100,000 North Carolinians ending up in the high-risk pool, which would lead to additional costs of as much as $1.5 billion.
"Just in North Carolina," he said. "So, all the money they’re talking about, I’m just talking about one state."
Even so, Upton’s reversal gave new energy to the GOP bill, which on Tuesday appeared to be well short of the votes needed for passage, with a number of moderates opposed.
Since no Democrats are expected to vote for the bill, Republicans can only lose 22 members of their party if everyone in the House casts a vote.
Even if the bill makes it out of the House, it remains well short of the 50 votes it would need in the Senate. A number of senators are unhappy with an earlier Congressional Budget Office estimate showing it would result in 24 million more people without insurance within a decade and skyrocketing premiums for lower-income people, particularly those over the age of 50.
At least eight Senate Republicans have expressed significant reservations about different elements of the bill, including the recent changes related to pre-existing conditions, and GOP leaders can only afford to lose two votes.
A wide array of industry groups and health advocates remained opposed to the GOP measure, despite the most recent changes.
AARP, the influential lobby that advocates for older Americans, says it remains opposed to the GOP bill, posting in a tweet that the Upton amendment is an "$8 billion giveaway to insurance companies; won’t help majority of those w/preexisting conditions."
The American Medical Association also said that none of the recent revisions soften its opposition.
"Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill — that millions of Americans will lose their health insurance as a direct result of this proposal," Andrew Gurman, the group’s president, said in a statement.
The decision to hold a vote was made before the text of Upton’s amendment was released, but health-care experts said the added funding is unlikely to make a big difference, unless very few states receive those waivers.
The $8 billion in funding is a “drop in the bucket,” said Matt Fiedler, a fellow at the Brookings Institution’s Center for Health Policy. He said the money, even including the bill’s stability fund and risk-pool funding, wouldn’t be enough to fully protect people with pre-existing conditions from facing higher costs.
The Center for American Progress, a progressive think tank in Washington, estimated that the Republican health bill, which includes about $130 billion over 10 years that could be used to help low-income Americans with pre-existing conditions, would fall about $20 billion short annually.
About 27% of adults have a pre-existing condition like cancer or heart disease that insurers refused to cover before Obamacare, said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.
“There are millions with pre-existing conditions,” he said.
Upton’s defection was significant because until last year, he was chairman of the Energy and Commerce Committee, which has jurisdiction over much of health-care policy, and he has been a staunch supporter of Obamacare repeal.
Voters have confronted lawmakers at town hall-style meetings across the U.S. in recent weeks with their concerns about losing health insurance under the GOP plan, giving some moderate Republican lawmakers jitters about backing the measure.
Yet party leaders have pushed to create a sense of urgency among their members to make good on a years-long promise to repeal former President Barack Obama’s signature health-care law now that Republicans control Washington. A scheduled vote in late March was scrapped at the last minute for lack of Republican support.
House Speaker Paul Ryan tried to boost the pressure on Republican moderates to advance the bill. “This is who we are. This will define us,” the speaker told Republicans during a private meeting, according to Representative Dennis Ross of Florida.
Upton on Tuesday cited the bill’s provision on pre-existing conditions as a reason for his defection. Under the bill — prior to his proposed amendment — states could allow insurers to charge higher premiums for people with pre-existing conditions who have had a gap in coverage of at least 63 days in the prior year. States could also let insurers charge older customers more than the original bill allowed -- at least five times more than younger ones, beginning in 2018.
“I told the leadership I cannot support the bill with this provision in it,” Upton said Tuesday. “It’s not going to get my ‘yes’ vote the way it is.”