The latest Republican health care idea could mean going back to a time when people with medical problems were charged much higher premiums for individual policies, experts say, as a quick deal among Republicans moved farther out of reach Wednesday.
Conservatives dialed up criticism of moderates for standing in the way. A White House official said progress is being made and all sides are talking, but offered no timetable for a handshake that would allow stalled Republican legislation to advance.
Rep. Mark Sanford, R-S.C., a member of the conservative House Freedom Caucus, said it's increasingly looking like there won't be a deal before Congress breaks for a two-week recess. Already in jeopardy, the GOP drive to repeal Obamacare could get more complicated.
"I've heard nothing of substance at this point that would break the logjam," Sanford said.
The new idea roughed out in negotiations between the White House and leaders of the conservative House Freedom Caucus would allow states to seek waivers of two requirements in the 2010 Affordable Care Act. One, known as community rating, forbids insurers from charging higher premiums on account of people's medical problems or pre-existing conditions. The other is the essential health benefits provision that spells out categories of benefits all insurance plans must cover.
Conservatives who want the federal government out of health care argue that those provisions have driven up premiums and decreased choice. The idea is to put states back in charge of insurance rules, reasoning that that would increase the availability of plans with lower premiums, attractive to younger, healthier customers.
But health care industry consultant Robert Laszewski said it would also open a "back door" to a system where the sick can get priced out of coverage.
"It's hard for me to believe that any state would take us back ... when it comes to the protections that consumers have for pre-existing conditions," Laszewski said. "There is no doubt that Obamacare as a system is not working very well, but nobody wants to go backward."
Republicans say their bill includes a fallback option for people with health problems. It would create a $100 billion fund that states can use for a variety of purposes, including high-risk insurance pools where people with medical problems can get coverage.
But Trish Riley, executive director of the National Academy for State Health Policy, said those didn't work well in the past. Patients tended to be very sick, and premiums were often too expensive.
"There would be real challenges for people with illnesses to get affordable coverage," Riley said. "You will get guaranteed access to coverage, but you won't be able to afford it." Her nonpartisan organization offers policy advice to states.
A former Obama administration insurance regulator said it's likely that the companies would press states to seek waivers under the latest Republican idea. That's because the broader GOP legislation would repeal unpopular ACA penalties on people who don't get covered, a move that insurers fear would let people postpone getting coverage until they are sick.
"Insurers are going to want some other filter to keep out people," said Karen Pollitz, an expert on individual health insurance, now with the nonpartisan Kaiser Family Foundation.
Trump administration officials and leading GOP legislators said they are not giving up trying to find common ground between conservatives and moderates. A late Tuesday meeting at the Capitol involving Vice President Mike Pence and about two dozen lawmakers produced no agreement, but White House legislative affairs director Marc Short said there was progress because both sides were "in the same room talking through the same issues."
Democrats were dismissive. "It's as if the president and Paul Ryan went to some of the Republicans and the Freedom Caucus and said, 'We can make this worse,'" Rep. Jan Schakowsky of Illinois said. "Now, let's remember that only 17 percent of the people in the United States approved of the last version."
Ryan's office, however, seemed to be keeping arms-length from the negotiations. Congress leaves town in days for a two-week recess, when lawmakers could face antagonistic grilling from voters at town hall meetings and the entire GOP drive might lose momentum.
Some conservatives said it might be good for lawmakers to go home and get an earful from constituents. Michael Needham, CEO of the advocacy group Heritage Action, accused House moderates of "intransigence" and said they "clearly want to keep Obamacare in place."
But a poll released earlier this week by the Kaiser Family Foundation offered reinforcement for lawmakers reluctant to forge ahead. It showed that 3 in 4 Americans want the Trump administration to make the law work. About 2 in 3 said they were glad the House GOP bill didn't pass last month. But people split evenly between wanting to keep or repeal the statute.