“We think the MacArthur amendment is a great way to lower premiums [and] give states more flexibility while protecting people with pre-existing conditions. Those are the three things we want to achieve,” Speaker Paul Ryan told reporters on Wednesday morning, after a private meeting of the House GOP. “I think it helps us get to consensus.”
Yet the speaker acknowledged they hadn’t quite reached that consensus, and without the support of enough moderates, the bill could still fall short. While MacArthur is the author of the compromise, he was already supporting the bill to begin with. A former insurance executive, he’s only beginning his second term in the House and is not seen as a driving force within the Republican conference. Another of the three co-chairmen of the Tuesday Group, Representative Charlie Dent of Pennsylvania, had come out against the GOP bill and quickly declared himself unmoved by MacArthur’s amendment. So did Representatives Dan Donovan of New York, Ileana Ros-Lehtinen of Florida, and Frank LoBiondo of New Jersey.
“It doesn’t address the concerns that I had,” Donovan told me in a phone interview on Wednesday. Representing Staten Island and a slice of southern Brooklyn, Donovan is the only House Republican from New York City, whose residents could be hit hard by provisions restricting the use of tax credits in the GOP bill. Opinions about the MacArthur amendment were mixed during a meeting of the Tuesday Group, he said. While some members liked the additional flexibility for states, “there’s others who may have balked or taken a step back” because of the changes to the pre-existing conditions guarantee, MacArthur said.
In fact, of the more than a dozen moderates who were opposed to the American Health Care Act a month ago, none have yet said the new compromise changes their mind.
And why should it? The new proposal retains the $800 billion in cuts to Medicaid that moderates are leery of supporting, and it is not likely to improve the projection of the Congressional Budget Office that 24 million fewer people would have health insurance a decade after the law’s enactment. And although Ryan pointed out that the bill would technically preserve the federal protection for people with pre-existing conditions, a firm GOP pledge, that guarantee would be worth next to nothing if states could easily seek a waiver exempting them from the mandate.
Politically, moderates have more to lose than members of the Freedom Caucus by supporting a bill that, one poll showed, fewer than one-in-five Americans supported. They are more likely to hail from more centrist and Democratic-leaning districts where support for Obamacare is stronger. In a rapid warning of the political blowback lawmakers could face, the Democratic Congressional Campaign Committee immediately launched digital ads attacking Republicans over a provision in the MacArthur amendment that would keep Obamacare’s consumer protections for members of Congress while allowing them to be scrapped for their constituents. Another liberal group, American Bridge, unveiled a new ad on Wednesday hitting Republicans for breaking President Trump’s promise to maintain the ban on discrimination based on pre-existing conditions.