(Reuters)

An influential group of House conservatives threw its support behind a new Republican plan to revise the Affordable Care Act, shifting political pressure onto GOP moderates to determine the effort’s fate.

The House Freedom Caucus said the amendment negotiated by its chairman, Rep. Mark Meadows (R-N.C.), along with moderate Rep. Tom MacArthur (R-N.J.), would drive down health-care costs by allowing states to opt out of certain rules under Obamacare.

“While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health-care costs,” the Freedom Caucus said Wednesday in an unattributed statement.

The decision came as three conservative advocacy groups — the Club for Growth, FreedomWorks and Heritage Action for America — also declared support for the plan, adding to its momentum.

“To be clear, this is not full repeal,” Heritage Action chief executive Michael Needham said in a statement. “The amendment does, however, represent important progress in what has been a disastrous process.”

(The Washington Post)

Attention now shifts to the moderate Tuesday Group, some of whose members will need to support the MacArthur amendment for it to pass.

Republican leadership can afford to lose only about 20 votes if most of the Freedom Caucus backs the measure. As of Wednesday afternoon, roughly 30 Republicans who are not members of the Freedom Caucus were either opposed or undecided.

Among them were Reps. Charlie Dent (Pa.), Jeff Denham (Calif.), Leonard Lance (N.J.), Ileana Ros-Lehtinen (Fla.) and Barbara Comstock (Va.), who have said they will not support the revised bill. Rep. Mike Coffman (Colo.), who supported the original bill, said he is now undecided. Rep. Carlos Curbelo (Fla.) said he wants a “thorough analysis” of the new measure before he decides.

Dent, co-chair of the Tuesday Group, said most of the moderates who opposed the original GOP bill were not privy to MacArthur’s negotiation and would vote “no” on his amendment.

He accused the Freedom Caucus, which thwarted Republicans’ first attempt to overhaul the health-care system under Trump, of trying to shirk responsibility for the effort. “It’s an exercise in blame-shifting,” Dent said.

The MacArthur amendment would allow states to opt out of certain insurance reforms under the Affordable Care Act, ­including the requirement that health plans cover essential medical benefits and the ban on charging customers higher premiums if they have preexisting conditions.

(Bastien Inzaurralde,Alice Li,Dalton Bennett/The Washington Post)

The Club for Growth issued a thinly veiled threat against moderate Republicans who might vote against the amendment if it comes to the floor.

In an interview Wednesday, president David McIntosh said centrist Republicans skeptical of the bill are “being smoked out” now that conservative organizations and the Freedom Caucus have endorsed it. He said advocates of the bill are “still gathering the votes.”

AARP came out against the amendment Wednesday, placing additional pressure on moderates to oppose it. The group said it will inform its membership how lawmakers vote.

Even if the bill does pass the House, it faces a skeptical audience in the Senate.

Several Republicans from large states that accepted the ACA’s Medicaid expansion previously opposed the House legislation for cutting that portion of the law, a move that would leave millions without health insurance. With only two votes to spare, those four Republicans could stop the legislation in its tracks in the upper chamber.

Matt House, a spokesman for Senate Minority Leader Charles E. Schumer (D-N.Y.) also said the Republicans’ latest plan would run afoul of Senate rules governing the reconciliation process, which protects legislation from filibuster.

But two GOP Senate aides familiar with the negotiations said they did not share the alarm Schumer’s team expressed.

“The MacArthur-Meadows language has been reviewed in the Senate and we believe it would not endanger the privilege of the House bill should it be included,” said one of the GOP Senate aides, who spoke on the condition of anonymity.

But the aide added a note of caution, saying that “final determinations” cannot be made until any new bill receives a score from the nonpartisan Congressional Budget Office and Democrats have a chance make their case to the Senate parliamentarian.

The revival of the Republican health-care effort is welcome news for the White House, particularly after last month’s defeat. But while Trump is eager to achieve as much as possible this week before Saturday marks the 100th day of his presidency, some in his party were wary of setting a deadline before reluctant members were ready to endorse the bill.

“We’ll vote on it when we get the votes,” House Speaker Paul D. Ryan (R-Wis.) told reporters at a news conference Wednesday.

“What we see is progress being made, showing that we’re moving and getting on the same page,” he said.

Momentum is building for the plan despite the revelation that, under its current language, members of Congress would be all but guaranteed to maintain health benefits that other Americans stand to lose.

That is because lawmakers obtain health insurance through a marketplace operated by the District of Columbia. The ­District is unlikely to seek a waiver to opt out of the ACA’s coverage requirements, meaning ­members’ plans would be left intact, even if insurers in their home states are allowed to cut benefits.

Meadows assured lawmakers the issue would be addressed.

“If you look at the text, it actually penalizes members of Congress and people in D.C.,” he said. “But we understand the optics, and we’re working on that to make sure that it gets fixed.”

House Minority Leader Nancy Pelosi (D-Calif.) said the amendment makes Republicans’ plan “even more cruel and costly for America’s families.”

“Families will be slammed with brutal premium increases,” she said. “Many would lose access to affordable health coverage entirely, on top of the 24 million hard-working Americans who would already lose insurance under the original TrumpCare language.”

Paul Kane, Kelsey Snell and Jenna Portnoy contributed to this report.