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Republicans seeking support for health-care plan push to address preexisting conditions

Rep. Fred Upton, who came out against the earlier revision on Tuesday, is the author of the latest amendment that provides more financial assistance for people with preexisting conditions.

WASHINGTON — Republicans sought Wednesday to rescue their push to overhaul the nation's health-care system, with a top GOP lawmaker proposing a new amendment in hopes of moving the controversial measure to passage after weeks of fits and starts.

Rep. Fred Upton (R., Mich.) is crafting a proposal to provide more financial assistance — $8 billion over five years — than the current House Republican plan offers to people with preexisting medical conditions.

The move come amid growing worries about the future for those people who could be denied coverage or charged more under the GOP plan if their states opt out of guaranteed protections in the Affordable Care Act. The states would have to set up high-risk pools to absorb some of the costs.

Upton's language is expected to be circulated among House Republicans on Wednesday as leaders try to gather enough support for vote this week to repeal and replace major parts of the ACA, known as Obamacare

But it remained unclear whether the latest proposed change to the measure would be enough to secure enough votes for passage. Some Republicans were supportive, while others remained opposed or unsure.

Another key question was whether $8 billion would be enough to help sicker patients cover their medical costs. Independent analysts were skeptical that the amendment would fund high-risk pools at the level needed for them to cover at-risk patients.

There was also uncertainty about how the bill would be scored by the nonpartisan Congressional Budget Office — and whether GOP leaders would hold off a vote until a score was released.

After meeting with President Trump and the White House Wednesday morning, Upton said his amendment would "more than cover those who might be impacted." He predicted the House Rules Committee would take up the measure on Thursday and that it is "likely now to pass the House."

But Rep. Billy Long (R., Mo.), who also participated in the White House meeting said, "There's still work to be done on the votes, I believe." Long and Upton were joined at thee White House meeting by Reps. Greg Walden (R., Ore.) and Michael Burgess (R., Texas), who added their support.

Long and Upton came out against the GOP bill earlier this week over concerns about preexisting conditions, dealing a major blow to the plan's chances. Upton is an influential former chairman of the House Energy and Commerce Committee, which has played a leading role in the GOP's health-care overhaul efforts.

The new amendment does not appear to run afoul of demands from the far-right House Freedom Caucus. That group still plans to support the plan, so long as any addition is limited to providing more money for high-risk pools and does not make any policy changes, according to an aide familiar with the group's thinking who spoke on condition of anonymity.

The White House has been putting heavy pressure on Speaker Paul Ryan (R., Wis.) to swiftly pass a health-care bill, amid fears that Republicans will lose their window of opportunity if the effort continues to drag out.

White House budget director Mick Mulvaney, who was seen in the Capitol on Wednesday, said in a Fox News interview that a vote is now possible as soon as Saturday.

In an interview with conservative radio host Hugh Hewitt, Ryan said would not commit to holding a vote on a specific timetable. The House is slated to go on recess Thursday until May 16.

"We'll make the announcement when we make the announcement," Ryan said.

Democrats, who have held firm against the GOP's repeal and replace push, said they were not impressed by the newly proposed changes.

"Trumpcare means heart-stopping premium increases for people with pre-existing conditions and no band-aid amendment will fix it," said House Minority Leader Nancy Pelosi (D., Calif.), who like many in her party have sought to associate the bill closely with Trump.

Upton's amendment would help some patients with expensive conditions such as cancer or diabetes pay premiums and out-of-pocket costs. It's aimed at providing reassurance that people with preexisting conditions wouldn't be priced out of the insurance marketplace, even though states could opt out of some protections for such patients.

But there is skepticism about whether $1.6 billion a year over five years is enough. According to an analysis from the Kaiser Family Foundation, the temporary high-risk pool created by the ACA covered just 100,000 people; the government paid out $2 billion in subsidies to that pool in one year.

Far more people with preexisting conditions are likely to lose health coverage under the GOP health care plan — some estimate around 5 million — and depending on how many states apply for the funds, $1.6 billion could be spread thin.

"For subsidies to cover 68 percent of enrollees' premium costs, as ACA tax credits do now in the individual market exchanges, the government would have to put up $32.7 billion annually," wrote Emily Gee, a health economist at the progressive Center for American Progress, in an analysis of the Republican plan. "Even after applying that subsidy, high-cost consumers would still owe $10,000 annually toward premiums."

The Upton change is the latest fix Republicans have added to their measure as they've tried to keep it viable. Last month, they added $15 billion for a program to reimburse insurers who cover patients with preexisting conditions — an effort to appease conservatives worried about lowering premiums.

It remained unclear whether all states would be able to apply for the newly proposed funding, or just states where patients with preexisting conditions could be charged higher premiums. Under a separate proposed amendment to the bill from Rep. Tom MacArthur (R., N.J.), which convinced many conservatives to sign onto the bill, states could apply for a federal waiver from a ban on insurers charging those patients more.

Amid the many swirling questions, there was still noticeable skepticism and opposition from some key GOP lawmakers. A Washington Post analysis shows 20 House Republicans either opposed to or leaning against the bill, and 29 more either undecided or unclear in their positions.

If no Democrats support the bill, the Republicans can lose no more than 22 GOP votes to pass it in the House.

"I just reiterated to @HouseGOP leaders that #AHCA in its current form fails to sufficiently protect Americans with pre-existing conditions," Rep. Carlos Curbelo (R., Fla.) tweeted Wednesday morning.

Rep. Mike Coffman (R., Colo.), who represents a swing district in suburban Denver that voted for Hillary Clinton, offered mixed reviews.

"If House Leadership will work to tighten protections for those with preexisting conditions, I'm a yes on sending this bill to the Senate for further consideration," he said in a statement Wednesday. "If not, I'm a no, and we'll go back to the drawing board to clean up the mess created by the Affordable Care Act."

The Washington Post's John Wagner, Kelsey Snell, Ed O'Keefe and Amber Phillips contributed to this report.

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