Trying to Revive Health Bill, G.O.P. Adds $15 Billion for Sickest Americans

APRIL 6, 2017

WASHINGTON — Under intense pressure from President Trump, House Republicans took a small step Thursday to revive legislation to dismantle the Affordable Care Act, adding a $15 billion fund to help insurers pay claims for their sickest customers.

Speaker Paul D. Ryan orchestrated a broad show of Republican support for the proposal, conceived as an amendment to the repeal bill that collapsed on the House floor two weeks ago. But Republicans said they still did not have enough votes to pass the bill, and with the House now on a two-week spring break, time is running out for their planned quick-strike repeal of President Barack Obama’s health care law.

Even so, Republicans said the amendment could help heal divisions in their conference and show progress to an impatient president, still smarting from a loss in his first showdown with Congress.

By a party-line vote of 9 to 2, the House Rules Committee on Thursday gave its blessing to the proposal, devised by Representatives Gary Palmer of Alabama and David Schweikert of Arizona, both members of the conservative House Freedom Caucus.

Mr. Palmer said the “risk-sharing program” would lower premiums by sparing insurers some costs. With lower prices, he said, more people would buy insurance.

He estimated that it would reduce the number of uninsured Americans by 1.2 million to 2.2 million. However, those gains would be dwarfed by other parts of the repeal bill, which the nonpartisan Congressional Budget Office says would result in 24 million more uninsured people compared with projections under current law.

Mr. Ryan said the new program would also help stabilize insurance markets. “One of the concerns we have is that insurers are leaving left and right, and people are down to, like, one choice, and in some cases no choices,” he said.

In the latest sign of turmoil, Aetna announced on Thursday that it would leave Iowa’s insurance exchange in 2018 because of “financial risk and an uncertain outlook for the marketplace.” That followed Monday’s announcement by Wellmark Blue Cross and Blue Shield, Iowa’s largest carrier, that it would not sell Affordable Care Act plans there next year.

This leaves a single insurer for the bulk of the state. “We’re deeply troubled by the angst and concern the Affordable Care Act is causing in Iowa,” the state’s insurance commissioner, Doug Ommen, said in a statement.

Under the latest Republican proposal, patients with high-cost conditions like metastatic cancer and AIDS would not be segregated in a separate insurance pool, but their insurers could receive extra payments, as the government would cover a share of claims exceeding a level specified by federal health officials.

Reactions to the proposal showed the political challenges facing Republicans.

Representative Nancy Pelosi of California, the House Democratic leader, said it did nothing to improve the legislation, which she called a “horrible, monstrous bill.”

And Representative Louie Gohmert, Republican of Texas, complained that the proposal gave “more power to the federal government to dictate what states have to do to get more money.”

But the White House continues to press for at least the appearance of action. House Republicans took the repeal bill to the floor on March 24 in response to an ultimatum from Mr. Trump, and the president demanded action again this week, just as House members were about to leave town.

“Who’s running this place?” Representative Alcee L. Hastings, Democrat of Florida, asked. “Is it the speaker, or is it the president? Are we letting the president tell us which amendment to report and when to report it?”

Mr. Palmer said his proposal was modeled on a program in Maine that reimbursed insurers for 90 percent of certain claims from $7,500 to $32,500 a year, and the full amount of claims past that.

Representative Tom MacArthur of New Jersey, a moderate Republican, said “the beauty of this proposal” was that it would be invisible to consumers with high-cost conditions. “They would be treated like everyone else, with respect,” he said, “and the high dollar amount of their claims would not result in premiums going up for everyone else.”

But the earliest Congress could get to the measure is April 25, when lawmakers return. And at that point, they will have just days to pass legislation to fund the government through September, and will then begin work on a budget for the fiscal year that starts Oct. 1.