WASHINGTON — House Republican leaders planned to hold a showdown vote Thursday on their bill to repeal and replace large portions of the Affordable Care Act after adding $8 billion to the measure to help cover insurance costs for people with pre-existing conditions.
“We have enough votes,” Representative Kevin McCarthy of California, the House majority leader, said Wednesday night. “It’ll pass.”
A breakthrough came earlier Wednesday thanks to an amendment proposed by Representative Fred Upton of Michigan, with the support of Representative Billy Long of Missouri, to add the money to the bill. The two Republican lawmakers had come out against the health care legislation, warning that it did not do enough to protect the sick, but they threw their support behind it on Wednesday.
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President Trump blessed Mr. Upton’s proposal at a White House meeting with the two lawmakers as he pressed hard for a vote that could at least ensure House approval of the bill, which embodies one of his central campaign promises. The vote Thursday will carry enormous potential consequences — for millions of patients, for Mr. Trump’s legislative agenda and for Speaker Paul D. Ryan, who has failed twice in recent weeks to bring the bill to the House floor.
The measure faces a wall of opposition from health care providers, disease advocates and retirees, and has been derided by many Senate Republicans, who are all but certain to reject vast portions of it should it clear the House. But clearing the House is a necessary step to keep alive the Republican promise — seven years in the making — to dismantle President Barack Obama’s signature domestic achievement.
Mr. Upton predicted that the bill was “likely” to pass the House, a tremendous reversal of momentum for a measure that has twice been pulled back from a vote for lack of support.
But Representative Carlos Curbelo, Republican of Florida, said: “I would highly doubt that any governor, especially the governor of a large state like Florida, would seek a waiver. I just don’t think that any state would want to carry the burden of managing health care more than they already do, through Medicaid.”
Mr. Curbelo illustrated the fluid politics swirling around the repeal bill. In a Twitter post on Thursday morning, he said he had just told House Republican leaders that the bill “in its current form fails to sufficiently protect Americans with pre-existing conditions.” In a late afternoon interview, he said, “I do not yet have a position on the bill.” He wanted to hear more from Mr. Upton, a respected Republican voice on health care.
The Affordable Care Act set up a special health insurance program for people with cancer, heart disease and other serious illnesses, to provide coverage until 2014, when insurers were forbidden to discriminate against people based on their health status. Claims far exceeded Obama administration estimates, exhausting most of the $5 billion provided by Congress.
The average cost per enrollee was more than $32,000 a year in 2012, according to a federal report on the program, and the cost varied widely among states, from a low of $4,300 to a high of $171,900 per enrollee.
Mr. Upton and Sean Spicer, the White House press secretary, said they believed that the money in the bill would be adequate. “It’s our understanding that the $8 billion over the five years will more than cover those that might be impacted and, as a consequence, keeps our pledge for those that, in fact, would be otherwise denied because of pre-existing illnesses,” Mr. Upton said at the White House.
To qualify for assistance under the Upton proposal, a person would have to live in a state with an approved waiver, have a pre-existing condition and be uninsured because of a failure to maintain “continuous coverage.”
The House Democratic leader, Nancy Pelosi of California, said the money was a pittance compared with the likely need. “It’s a joke,” she said. “It’s a very sad, deadly joke.”
The latest amendments to the bill amount to “a hoax on pre-existing conditions,” Ms. Pelosi said. “If Republicans have their way, Americans with pre-existing conditions will be pushed off their insurance and segregated into high-risk pools where they face soaring cost, worse coverage and restricted care.”