Uphill battle looms as Trump seeks revamped healthcare plan


UPDATE 1-Uphill battle looms as Trump seeks revamped healthcare plan

* Trump plays down next week as goal for passage
    * Republicans can't afford defections with Democrats opposed
    * Trump has no major legislative victory since taking office

 (Adds Trump's comments on timing of congressional action,
paragraph 3, House legislative schedule not including healthcare
next week, paragraph 5)
    By Susan CornwellWASHINGTON, April 21 (Reuters) - President Donald Trump,
striving to make good on a top campaign promise, is pushing his
fellow Republicans who control Congress to pass revamped
healthcare legislation but the same intraparty squabbling that
torpedoed it last month could do it again.
    Trump is looking for his first major legislative victory
since taking office in January. House of Representatives
Republicans are exploring compromises aimed at satisfying the
party's most conservative members without antagonizing its
moderates, but it remained unclear on Friday whether a viable
bill would emerge.
    Trump on Friday played down the need for Congress to act on
the legislation before he reaches his 100th day in office next
weekend, telling reporters, "We'll see what happens - no
particular rush." Trump on Thursday had predicted "a good chance
of getting it soon," either "next week or shortly thereafter."
On Friday, he said it "doesn't matter if it's next week."
    Congress, returning from a recess next week, also will be
working against the clock to pass legislation to keep the
government funded past April 28 and avert a federal shutdown.
    Healthcare legislation did not appear on the schedule
released on Friday by House Republican leaders of bills to be
considered next week.
    "We're going to get it done when it's appropriate in terms
of getting to that 216," White House spokesman Sean Spicer told
reporters, referring to the vote total needed for House passage
before the bill goes to the Senate.
    Trump's party cannot afford defections because Democrats
remain unified against the Republican quest to repeal and
replace the Affordable Care Act, Democratic former President
Barack Obama's signature domestic policy achievement, dubbed
Obamacare. Trump campaigned on a pledge to discard Obamacare.
    In a stinging setback for Trump, Speaker Paul Ryan pulled
the legislation from the House floor on March 24 before allowing
it to come to a vote amid a revolt by conservatives in a faction
called the House Freedom Caucus and moderates unhappy with
concessions to the conservatives. [nL2N1H10CS]
    Republicans have called Obamacare a government overreach.
The law enabled 20 million Americans to obtain insurance, many
through an expansion of the Medicaid program for the poor.
    A senior House Republican aide said it was not clear whether
a revamped Republican plan can attract 216 votes, adding that
without a legislative text it was impossible to do a vote count
to assess its chances.

    Moderate Republican Representative Tom MacArthur is pushing
a proposal to allow states to waive some Obamacare provisions.
MacArthur's office said he has discussed it with other
Republican lawmakers, the House leadership and the White House.
    No text has emerged, but an outline of his proposal said
states could seek to relax "essential benefits" that Obamacare
requires insurance plans to cover, such as emergency room trips,
maternity and newborn care, and mental health services.
    States also could request waivers to Obamacare's ban on
insurers charging sick customers higher premiums than healthy
customers. But states would have to establish "high-risk pools"
using government funds to help pay for insurance for people with
costly medical conditions.
    Representative Rodney Davis told CNN on Friday he did not
know what was in the deal, but added, "I'm not going to be for a
plan that is going to allow for pre-existing conditions to not
be covered." MacArthur and Davis are members of the centrist
House Republican Tuesday Group.
    Freedom Caucus member Representative Dave Brat told CNN the
new proposal gives states more say healthcare but was the "same
fundamental bill" that collapsed last month.
    The Republican plan, as written last month, would end the
Medicaid expansion, let states impose work requirements on some
Medicaid recipients, rescind a range of Obamacare taxes, get rid
of a penalty on people who refuse to obtain insurance, and ditch
Obamacare's income-based subsidies to help people buy insurance
while creating less-generous age-based tax credits.
    The nonpartisan Congressional Budget Office forecast the
earlier version of the plan would increase by 24 million the
number of Americans without medical insurance by 2026.
    During a Thursday conference call with House Democrats,
their leader, Nancy Pelosi, urged them to remain united against
the Republican legislation, saying it would increase healthcare
costs and provide less insurance coverage, an aide who was on
the telephone call said.

FACTBOX-Republicans seek to scrap Obamacare 'essential health
benefits'    [nL2N1H00QQ]
 (Reporting by Susan Cornwell; Additional reporting by Ayesha
Rascoe, Richard Cowan, Doina Chiacu and Mohammad Zargham;
Editing by Will Dunham)


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