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The fate of the Republican health bill is in House moderates’ hands

Rep. Charlie Dent (R-PA)
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Rep. Charlie Dent (R-PA)

House Republicans are closer to passing a health bill than they've ever been — but it's still not certain they can rack up enough votes for a win. And this time, the fate of the bill comes down to the House moderates, a group of 50-plus members, many of whom have grown increasingly skeptical as the American Health Care Act moves further to the right.

Until now, the Republican effort to repeal and replace Obamacare has been a nonstarter for the party's most conservative faction, the House Freedom Caucus, which successfully blocked a vote on AHCA in the first round of negotiations in late March.

But this time, the Freedom Caucus has officially backed the bill as a group for the first time. That means at least 80 percent of the roughly 40-person caucus will vote yes, should the latest amendment be included.

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The amendment, negotiated by Freedom Caucus Chair Mark Meadows and Rep. Tom MacArthur, a member of the House Republican's moderate Tuesday Group, would allow states to waive key Obamacare regulations that stopped insurance agencies from charging people with preexisting conditions higher premiums and give states the option to opt out of requirements that they cover as "essential health benefits," such as emergency services and maternity care. The amendment moves the bill further to the right by giving states the option to roll back more of Obamacare's requirements.

Freedom Caucus member Rep. Dave Brat called the deal the "sweet spot" Republicans have been trying so desperately to find.

But while Meadows appears to have successfully gotten conservatives in line, it's become increasingly clear that MacArthur does not speak for the moderates. Instead, Rep. Charlie Dent, who chairs the Tuesday Group, has come out against the bill, and said he was surprised an amendment that moves the bill to the right came from a member of his group. He's not alone.

"My sense is that the members of our group who were opposed to the bill before remain opposed. Nothing's changed," Dent told reporters. In other words, with Freedom Caucus members on board, the vote definitely got a lot closer — but now it's in the hands of the moderates, who will have to decide whether voting with their party will be too politically dangerous in their constituencies.

It's not clear how many moderate votes this has changed

Republicans need 216 votes to pass the health bill — they can afford to lose 22 votes. Already a handful of other moderates have said they remain a no vote on the bill, including Reps. Barbara Comstock, Jeff Denham, and Dan Donovan.

Meanwhile, the amendment has moved at least one moderate Republican member away from a yes. With the amendment, Rep. Mike Coffman, who used to support the health bill, now says he is a "strong no." Rep. Tom Reed too said he is less enthusiastic about the bill. He was a yes and now is "leaning yes," adding that he has to review the legislative text.

By press time, there had yet to be a moderate member that had changed from a no to a yes. Rep. Thomas Massie, who was previously a "hell no," said he was now just a "no."

Huffington Post's Matt Fuller pointed out that many moderates resorted to the canned "haven't had a chance to look at it" line to buy more time.

Politically, it will be a difficult vote for moderates and for members who are part of what Vox's Andrew Prokop has dubbed the "Coverage Caucus" — Republicans who, out of concern for their constituents or their own political future, don't want to vote for a bill that would cover significantly fewer people than Obamacare. This amendment, which could result in higher premiums for people who are already sick, does not assuage these concerns.

Even Brat recognized that this amendment will be a close vote. If it manages to pass the House only to get destroyed in the Senate (which is highly possible), it's probably not going to find success in the House again, he said.

"I just think if [senators] have eyes to see how tight this thing is," he said, "if they change more than a iota — they know what they are doing, they are rational, they see what it was like to get to the sweet spot here. Any big changes, I don't think it will go over too well."

To be clear, the chances that the Senate will vote for this bill as is are basically zero.

Until now, AHCA was a Catch-22. This time might be different.

So far, every attempt to amend the health bill has resulted in an impasse.

Any measure to appease the party's most conservative faction would lose votes among the party's more moderate members. Now it's slightly different: The Freedom Caucus is on board, and it's up to moderates to sign on.

It's clear that moderate members are skeptical. But one GOP aide points out that it's no longer the same Catch-22 that AHCA used to be, simply because the amendment "doesn't change what their states are actually doing." In other words, a lot of the members concerned about losing the preexisting condition rule and essential health benefits requirements are from states that probably won't even waive these Obamacare regulations. "That's why this isn't really more conservative," the GOP aide said.

All that goes to say that Republicans truly could be closer to passing a health bill in the House for now.

According to a senior congressional aide close to leadership, the House will wait until it has the votes before moving to the floor for a vote. It looks like it's closer — it just depends on how many moderates will sign on.