By Peter Sullivan and Jessie Hellmann - 04-26-17 15:17 PM EDT
Republicans took a serious step forward in their effort to replace ObamaCare on Wednesday when the conservative House Freedom Caucus endorsed revised legislation.
Speaker Paul Ryan (R-Wis.) said Wednesday that the amendment "helps us get to consensus" but did not say how close Republicans are to the majority vote necessary to pass legislation through the House.
The amendment managed to flip a number of prominent conservatives from no to yes, including Reps. Dave Brat (R-Va.), Mo Brooks (R-Ala.) and Scott DesJarlai
(R-Tenn.), all Freedom Caucus members.
Rep. Jim Jordan (R-Ohio), a former chairman of the Freedom Caucus and a strong opponent of the original bill, also announced his support.
"While I remain committed to replacing ObamaCare entirely, I can support this new version of the bill moving forward. It is our best chance to pass a bill through the House that will actually reduce the cost of health insurance for everyday Americans," Jordan said in a statement.
Despite chatter that a vote could come as soon as this week, a GOP leadership aide cautioned against talk of setting dates, saying leaders would only bring it up when they know they have the votes for it to pass.
Moderates remain elusive, and several centrist lawmakers said they could not say whether they could support the bill.
One centrist Republican, Rep. Mike Coffman (Colo.), supported the earlier bill but now says he is undecided, underscoring the uncertainty.
"I made it very clear ... to my constituents that I'm going to protect pre-existing conditions, and so this is a fairly complicated proposal, so I've really got to review it," Coffman said.
So far, no moderates have moved from no to yes on the bill, and there are divisions within the moderate Tuesday Group over Rep. Tom MacArthur's (R-N.J.) decision to negotiate changes to the earlier bill with Rep. Mark Meadows (R-N.C.), the leader of the House Freedom Caucus.
Many centrists said privately that MacArthur, co-chairman of the Tuesday Group, was not negotiating on their behalf.
Several moderates also pointed out that there are problems in the underlying bill that remain unaddressed. The bill is still projected to result in 24 million fewer people with insurance over a decade and has deep cuts to Medicaid, which moderates like Rep. Charlie Dent (Pa.) object to.
The new amendment from MacArthur and Meadows would allow states to apply for waivers opting out of a core ObamaCare protection for people with pre-existing conditions, which conservatives say drives up premiums.
Many lawmakers faced contentious town halls this month where constituents pressed them to preserve pre-existing condition protections, which could make it harder for centrists with one eye on next year's midterms to go along with the new bill.
"Those are the kind of concerns that obviously make me have to think long and hard about it," said moderate Rep. Ryan Costello (R-Pa.) on Wednesday, referring to the pre-existing condition changes.
Many moderate lawmakers leaving a meeting of the Tuesday Group on Wednesday said they were undecided and needed to learn more about the new amendment.
Dent, the other co-chairman of the Tuesday Group and still a firm no on the bill, said he thought the changes had done little to sway moderates.
"My sense is the members of our group who were opposed to the bill before remain opposed, nothing's changed. That's my sense," Dent told reporters. "You have to ask each one of them individually."
Several moderates, including Reps. Leonard Lance (R-N.J.), Dan Donovan (R-N.Y.), Frank LoBiondo (R-N.J.) and Ileana Ros-Lehtinen (R-Fla.) have all said previously they're still opposed to the bill, even with the changes.
The MacArthur-Meadows amendment allows states to apply for a waiver to ObamaCare's "community rating" requirement, which prevents insurers from charging higher premiums to sick people.
If that were waived, insurers would be allowed to charge people with pre-existing conditions much higher premiums due to their illnesses, putting coverage out of reach for many.
A study from the liberal Center for American Progress released last week found that waiving community rating would lead to sharp annual premium increases for sick people, such as an increase of roughly $4,000 for those with asthma or as much as $71,000 for those with severe cancer.
States could also apply for waivers to ObamaCare's essential health benefits, which mandate that insurance plans cover a range of services such as mental healthcare and prescription drugs.
There is also tension within the Tuesday Group over MacArthur's move to negotiate with the Freedom Caucus.
Dent noted that many Tuesday Group members had asked that the co-chairmen not negotiate, and to leave the discussions up to the standard committees that deal with healthcare, Ways and Means and Energy and Commerce.
"The only thing I will say is many members of the Tuesday Group made it very clear to me that they didn't want me or anyone else negotiating," Dent said.
MacArthur said his work was done as a member of Congress, not as a representative of the Tuesday Group.
"I have introduced an amendment as an independent member of Congress. I'm not speaking for other groups, and you'll have to ask other members of the Tuesday Group what their view is," MacArthur told reporters.
Dent called the new bill an "exercise in blame-shifting" by the Freedom Caucus to avoid the heat they took for standing in the way of the previous version. He argued the measure does not stand a chance in the Senate.
MacArthur spoke in the conference meeting in support of the changes and received applause at the end.
Meadows was the sole lawmaker to give MacArthur a standing ovation, a lawmaker said.
Updated at 8:06 p.m.