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House Speaker Ryan says no 'bill ... or agreement' yet on new Obamacare replacement plan

House Speaker Paul Ryan (R-WI) listens to questions during a media briefing after attending a closed House Republican conference, on Capitol Hill, on April 4, 2017 in Washington, DC. Speaker Ryan spoke on issues regarding healthcare and House Intelligence Committee Chairman Nunes.
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House Speaker Paul Ryan (R-WI) listens to questions during a media briefing after attending a closed House Republican conference, on Capitol Hill, on April 4, 2017 in Washington, DC. Speaker Ryan spoke on issues regarding healthcare and House Intelligence Committee Chairman Nunes.

Hold your horses.

House Speaker Paul Ryan said Tuesday a renewed effort to repeal and replace major parts of Obamacare is still at a "conceptual stage" — as the GOP caucus tries to resolve concerns among their members that have stymied the effort.

"We're throwing around concepts to improve the bill," Ryan said, hours after The New York Times reported how House conservatives have discussed potential new provisions in a repeal bill.

"That doesn't mean that we have language and text that's ready to go, and the votes are lined up," Ryan said. "We don't have a bill, text or agreement yet."

But he also said: "We have very productive conversations occurring among our members."

The provisions reportedly discussed among conservatives include allowing states to decide whether to let insurers offer plans that do not cover a standard minimum set of health benefits — as Obamacare mandates.

Another proposal is to eliminate a requirement that insurers charge people who are the same age the same amount in premiums.

The changes, if enacted, would likely mean that insurers could offer skimpier plans than they do now — leaving customers with much more responsibility for their direct health costs — and higher premiums for many people who have pre-existing conditions.

Ryan told reporters that "it's premature to say ... where we're at because we're at that conceptual stage right now."

"Now I won't get into the details of these things other than to say this is all about getting to the conceptual stage."

"We want to make sure that when we go that we have the votes to pass this bill," Ryan said.

Ryan didn't have the votes to pass the bill almost two weeks ago, when he canceled a planned vote on the GOP's American Health Care Act by the full House after it became clear that too many of his fellow Republicans opposed it.

Members of the conservative Freedom Caucus and the moderate Tuesday Group had serious qualms about the bill. About 30 or so members were on the record as opposing the plan at the time the vote was canceled.

Conservatives believed it did not go far enough to repeal the Affordable Care Act, while moderates were concerned about the bill's scaling back of federal aid to lower- and moderate-income Americans to get health coverage.

Ryan, referring to that division on Tuesday, said, "It's important that we just don't win the votes of one caucus, or one group, but that we get the votes and the consensus of 216 of our members." That is the number of votes needed to pass the bill out of the House and send it to the Senate.

Ryan said a key goal for the caucus is "getting premiums down" for individual health plan.

"This is all about making more affordable premiums," he said.

However, it is not clear that even if Republicans can cobble together a bill that would win passage in the House that it would survive in the Senate.

A number of GOP senators have said they oppose rolling back the expansion of Medicaid benefits achieved through the ACA, and also oppose defunding Planned Parenthood, as the prior version of the Republican bill would have done for one year.

Another big hurdle in the Senate, or even the House, would be how any new bill is evaluated by the nonpartisan Congressional Budget Office.

The CBO said a prior version of the GOP bill would have led to 14 million more Americans becoming uninsured next year than would be the case if Obamacare remained in effect, and that by 2026 there would be 24 million more uninsured Americans.

And while premiums would be lower under the GOP bill than under Obamacare by 2026, the prices of individual health plans would be higher with the Republican plan in 2018 and 2019 than under Obamacare, according to CBO's projections.

Those projections, as well as other concerns, made the GOP plan deeply unpopular among the general public.