Trumpcare Has a Pulse But Remains on Life Support

American Healthcare Act has gotten a second life, and Trump is eager to see it passed by his 100th day in office

The Trump administration is pushing hard for the passage of a GOP health care bill. Credit: Al Drago/Redux

Just weeks ago, the White House and Republican leaders in Congress suffered the embarrassment of having to pull Trumpcare from the House floor after both the far-right wing of the party and moderates bolted. But the bill now has a second life.

The new proposal, known as the MacArthur Amendment in honor of its lead author, New Jersey Rep. Tom MacArthur, would allow states to apply for a waiver with the federal government to get out of some of Obamacare's requirements, like insurance companies not being able to charge people more if they have a preexisting condition.

That change brought the majority of the three dozen or so members of the House Freedom Caucus on board and seems to offer leaders a path forward.

"We think the MacArthur Amendment is a great way to lower premiums, give states more flexibility," House Speaker Paul Ryan told reporters Wednesday. "We think it's constructive."

That doesn't mean the GOP's attempt to overhaul nearly 20 percent of the American economy will be easy. Even supporters of the new deal aren't totally in love with the compromise.

"It's not a repeal – let's be clear," Republican Rep. Mark Sanford of South Carolina tells Rolling Stone. "I think it's very important to be clear with the American public and not to oversell this thing: Oh we repealed it. No, we haven't repealed the Affordable Care Act. We have trimmed back a couple of its key features. But there are a couple of key features that are still in there. The fact that a state has to get a waiver says how much it is in force and effect."

But Sanford and others came on board because they argue this is the furthest Republicans in the House are willing to go. He adds that the Freedom Caucus members were able to flex their muscles and move the legislation toward their preferences, like on allowing states to add work requirements for Medicaid recipients and tweaking the taxes that came with the Affordable Care Act.

While the Freedom Caucus is known for pushing out former Speaker John Boehner, shutting down the government under President Obama and opposing most every spending bill crafted by their Republican colleagues, this successful negotiation shows that President Trump and House leaders are willing to put their demands over the needs of the more moderate wing of the party.

"Unequivocally so," Sanford says. "From a conservative's vantage point, there are a number of different things that have been added, and I think we got to the high-water mark on what could or couldn't be added, and people were ready to strike a deal and move on."

But not every right-leaning lawmaker is on board with the new proposal.

"I think the Freedom Caucus has done a good job of making the bill less bad," Sen. Rand Paul told reporters at the Capitol. "For me it's a big stumbling block, still, that there's taxpayer money that's being given to insurance companies, and I'm just not in favor of taxpayer money going to insurance companies."

Then there are the moderates. The changes in the bill to make it more palatable to the right flank of the party have freaked out many lawmakers in competitive districts who are already at risk of getting booted from office by angry voters in the 2018 midterms.

"I am opposed to the bill, and I think the Democrats should come to the table on the issue of the exchanges, which I think is an area that needs reform immediately," Republican New Jersey Rep. Leonard Lance tells Rolling Stone. "I want to vote for a proposal that lowers premiums for the American people, and I don't think this bill does that."

It's still unclear if Republican leaders have the votes to get the bill over the finish line. The new amendment left many Republicans in a quandary: support this bill – which could be their last chance this year to carry through on their promise to do away with the ACA – or appear to be an obstructionist and bad team player. But some conservatives are still asking why they can't just scrap the law altogether and start over.

"I'm trying to make sure we're not making this more complicated than we should," says Rep. Paul Gosar. "Wouldn't it be nice to repeal the thing? And start simple? We talk about market-based applications, and that's hardly what we're trying to do with the [American Healthcare Act]."

Given that Trump is nearing his 100th day in office with no real legislative accomplishment to speak of, the administration is working overtime to get Trumpcare through.

The health care fight has eaten up a lot of time and left other key goals of the party on hold, but so far the Republican-on-Republican brawl has only taken place in the House. Many Senate party members are lukewarm to the proposal and are promising major changes to the bill before they'd support it. Those changes likely won't be palatable to the Freedom Caucus, leaving some Republicans wondering why they should risk their careers on a bill that may never see the light of the Oval Office.