Health care is the most talked-about thing on Capitol Hill right now, but a few members of Congress — including two Minnesota Republicans — aren’t saying much about it.
The GOP plan to repeal and replace the Affordable Care Act, titled the American Health Care Act or AHCA, fell apart in March because it couldn’t win enough support from the moderate and conservative wings of the party.
Last week, the once-dead bill got new life: Rep. Tom MacArthur, a New Jersey moderate, and leaders of the hard-line Freedom Caucus agreed on an amendment to the AHCA, which would give states a path to opting out of key provisions of Obamacare.
Though that move pleased many conservatives, the new language is creating problems elsewhere in the House GOP. Stalwart Republican members and supporters of leaders like Speaker Paul Ryan — who is still strongly backing the bill — have fled, saying they can’t support the amended legislation.
The margin for error for the GOP is growing razor-thin: assuming unanimous Democratic opposition, they can only afford to lose 22 of their own. They already have lost 20, so all eyes are on the dwindling pool of members who remain undecided.
Two of Minnesota’s three Republican representatives, Reps. Erik Paulsen and Tom Emmer, are in that group: neither has taken an official position on the newest version of the bill as House leadership aims to bring it before lawmakers soon.
Paulsen needs to review the text
Paulsen, the Republican who has represented the west metro’s 3rd District since 2009, is generally a reliable team player for GOP leadership. He supported the first version of the AHCA, and voted to pass it in the Ways and Means Committee.
Since the MacArthur language was introduced last week, though, Paulsen has not taken a position, and has been evasive in his replies to press questions.
On Friday, Paulsen informed MinnPost that he was still reading the text of the amendment, which was posted to the website of the House Rules Committee the previous Wednesday night. He said to check in with him on Tuesday about his position.
On Tuesday, when asked about his position, Paulsen told MinnPost the text “hasn’t been posted yet.” When asked about the amendment in question — whose text was released the week prior and is currently being debated and scrutinized in Congress — Paulsen said he was still waiting for it to be posted.
There are a few reasons why Paulsen could be holding out. For one, even though the new version of the AHCA was sold as a compromise, the language is scaring off a broad range of Republicans because of what it could mean for coverage for those with pre-existing conditions.
The amendment would permit states, starting next year, to apply for waivers exempting them from foundational elements of Obamacare that the AHCA would, in letter, keep in place.
Concern centers around states’ ability to opt out of Obamacare’s community rating and essential health benefits provisions, both of which protect those with pre-existing conditions from being charged more for their coverage by insurers.
This has prompted right-of-center Republicans, and even more conservative ones, to announce their opposition. Missouri Republican Rep. Billy Long, a Trump supporter and stalwart Republican, said the MacArthur amendment “strips away any guarantee that pre-existing conditions would be covered and affordable.” (Politico called it a “surprise defection.”)
Paulsen has indicated that any weakening of pre-existing condition protection would be a deal-breaker for him. In a form letter to a constituent dated April 14, Paulsen said the following: “Any reform efforts should maintain important provisions that expand access to health care. These include protecting patients with pre-existing conditions, allowing dependents up to age 26 to stay on their parent’s plan, and prohibiting insurers from placing lifetime caps on the amount of care they will provide.”
(The AARP, which opposes the health care bill, argued that the MacArthur amendment could threaten protections against lifetime caps on care, too.)
Paulsen is also one of 23 Republicans who won districts carried by Hillary Clinton in the 2016 election. (CD3 voters preferred Clinton to Trump by nine points, but delivered Paulsen another double-digit re-election victory.)
The Eden Prairie congressman, then, faces a tough calculus. He has faced intense heat from some constituents over his stance on health care reform. If he supports this version of the AHCA, it could have significant negative political ramifications for him. At the same time, Paulsen is historically reluctant to depart from leadership, and with such a narrow margin, they’ll need his support on this.
Emmer leaning yes?
Into his second term in Congress, Emmer has also established himself as an ally of GOP leadership: he holds a top post at the party’s House campaign arm and helped whip support for the first version of the AHCA.
Emmer has not publicly said where he stands on the latest version. (MinnPost has contacted his office for comment — we’ll update if we hear back.)
The Huffington Post’s Matt Fuller, who has been tracking the AHCA very closely, has a public whip count that lists Emmer as one of 14 Republicans who are leaning yes. (Paulsen is one of 13 purely undecideds.)
Compared to Paulsen, the political stakes for Emmer — the incumbent Minnesota Republican with the safest district — are relatively low for this vote, at least in the short term.
It could be the long view that is giving him pause, says Steven Schier, professor of politics at Carleton College. “Efforts by the House GOP to amend the Affordable Care Act have thus far proven unpopular,” he told MinnPost. “It seems that whichever political party takes charge of changing health care incurs a considerable political penalty. That helps to explain the wariness of Reps. Paulsen and Emmer regarding support of the latest House GOP health reform plan.”
The Minnesota outlier is freshman Rep. Jason Lewis. He told MinnPost last week that he plans to support the version of the AHCA as proposed.
It is unclear when, or if, the health care bill will come up for a vote, but GOP leaders have said it could be as soon as Wednesday.