Influential Republican Attacks Party’s New Health Care Bill

WASHINGTON — The former chairman of one of the House committees that drafted legislation to repeal and replace large parts of the Affordable Care Act came out against a new version of the bill on Tuesday, saying the measure now “torpedoes” protections for people with pre-existing medical conditions.

Representative Fred Upton of Michigan, the former chairman of the House Energy and Commerce Committee, declared on a local radio show, “I cannot support the bill with this provision in it,” just as House Speaker Paul D. Ryan was insisting that the legislation would protect the sick.

The loss of Mr. Upton, an influential Republican voice on health care, was a huge blow, and it came as Republican leaders faced an onslaught of advocacy groups, political attack ads and even a late-night talk show host, Jimmy Kimmel, saying the bill would harm the nation’s most vulnerable citizens. Mr. Upton was explicit: The concessions made to win over the hard-line conservatives in the House Freedom Caucus were costing the leadership support from more moderate Republicans.

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“I’m not at all comfortable with removing that protection,” Mr. Upton said of the pre-existing condition concession.

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Mr. Ryan said Republicans were “making very good progress with our members,” but offered no indication of when a vote might be held on the measure. Trump administration officials have said a vote could come as early as Wednesday, but as House Republican leaders scrambled to assemble a majority, a quick vote appeared unlikely.

“There are a few layers of protections for pre-existing conditions in this bill,” Mr. Ryan said at a news conference. “What’s important is we want to have a situation where people can afford their health insurance. We want to have a situation where people have a choice of health insurers. That’s not happening in Obamacare.”

Mr. Ryan and his fellow Republican leaders, under intense pressure from the White House, are struggling to round up the support for a revised version of their bill to repeal and replace President Barack Obama’s signature domestic achievement.

After the failure of their earlier repeal bill in March, they have held off moving forward with a vote while they try to build support for the updated measure.

At the heart of the debate is an amendment to the repeal bill proposed by Representative Tom MacArthur, Republican of New Jersey, with the blessing of House Republican leaders.

The amendment won over the hard-line House Freedom Caucus last week, in part by giving state governments the ability to apply for waivers from the existing law’s required “essential health benefits,” such as maternity, mental health and emergency care, and from rules that generally mandate the same rates for people of the same age, regardless of their medical conditions.

The MacArthur amendment has given pause to numerous moderate Republicans, in large part because of concerns over whether it would allow states to gut those consumer protections.

As Mr. Ryan was defending the plan, the Association of American Medical Colleges came out against it, joining the American Medical Association and a host of disease advocacy groups. Dr. Darrell G. Kirch, the president and chief executive of the medical colleges group, said the newest version of the repeal bill “dilutes protections for many Americans and would leave individuals with pre-existing conditions facing higher premiums and reduced access to vital care.”

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Under the amendment, states could obtain a waiver from a provision of the Affordable Care Act that prohibits insurers from charging higher rates to people with pre-existing conditions.

With a waiver, states could permit insurers to charge higher premiums based on the “health status” of a person who had experienced a gap in coverage. To qualify for a waiver, a state would have to have an alternative mechanism such as a high-risk pool or a reinsurance program to provide or subsidize coverage for people with serious illnesses.

“States can’t leave people with pre-existing conditions high and dry,” Mr. MacArthur said Tuesday, defending his proposal. “They must have a risk pool, which would protect people from being priced out of the market.”

Mr. Ryan is struggling to win the public-relations battle over how his legislation would affect consumers.

On his TV show Monday, Mr. Kimmel delivered a tearful opening monologue in which he revealed that his newborn son had been found to have severe heart defects, and he went on to talk about the issue of pre-existing conditions.

Both the Democratic Senatorial Campaign Committee and the Democratic super PAC American Bridge are running attack ads to undermine Republican support.

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