This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Washington • House Republican leaders are making last-minute plans to modify their stalled health-care bill Thursday in response to pressure from the White House to show progress toward passing the bill before lawmakers leave for a two-week recess.

Four people familiar with the plans, including a House member who has been involved in the health-care discussions, said an amendment providing for "high-risk pools" — a mechanism to subsidize pricier insurance coverage for the seriously ill — will be added to the health-care bill at a Rules Committee meeting Thursday.

Vice President Mike Pence requested the change, according to several individuals briefed on it, which was made hours after House Speaker Paul D. Ryan made an evening visit to the White House to discuss the issue with President Donald Trump, Pence and other officials. These individuals asked for anonymity in order to discuss private conversations.

"While we're still working toward a final agreement, progress was made this week on some new policy," one House Republican aide said. "To keep advancing our efforts, the Rules Committee will meet ⅛Thursday⅜ to mark up language that would add this to the bill."

Ryan and House Majority Leader Kevin McCarthy, R-Calif., met in White House Chief of Staff Reince Priebus's office Wednesday along with Pence and a slew of the president's top aides, including Budget Director Mick Mulvaney, chief strategist Stephen K. Bannon and Domestic Policy Council Director Andrew Bremberg.

According to a senior White House official not authorized to speak publicly, Pence conveyed in the intense discussion that the president wanted the House to move immediately on health care in order to keep the effort of repealing the 2010 Affordable Care Act alive. Trump needs to score a short-term win on the issue, the vice president emphasized, since otherwise lawmakers may retreat.

A House aide said the White House painted a "dire" political picture of what would happen if Republicans fail to act on health care.

Priebus — who has close ties to Ryan and other congressional leaders — also pressed for action, one White House official said. Bannon has echoed these calls for action and was one of the most vocal players in pushing for a contentious floor vote in the hours before the legislation was initially shelved, believing that only a "foot on the throat" of House Republicans would get them to fall in line, according to one person close to Bannon.

Ryan agreed to move ahead with the amendment on risk pools, which is sponsored by Reps. Gary Palmer, R-Ala., and David Schweikert, R-Ariz., but there is no guarantee the measure will come up for a vote on the House floor by the end of the week.

In fact, several Republicans privately acknowledge that given current fractures within the House GOP, it remains unclear whether there is sufficient support to pass an overall health-care overhaul. And Senate Republicans are still leery of House-driven efforts to shift the party debate on health-care policy to the right.

White House officials are also facing swirling political dynamics in the House that they cannot necessarily control, despite the relationships some of them have cultivated on Capitol Hill. Pence, a former House member and conservative, shares much of the ideology but not the tactics of the House Freedom Caucus and his political capital to sway them has its limits. He also does not know some of its members well since he left the House after winning Indiana's governorship in 2012.

While White House officials have also discussed in the past week whether an eventual compromise with Democrats could be possible, according to one individual who asked for anonymity in order to speak frankly, there is no evidence that Trump and his aides are pursuing that path.

Ryan spoke briefly about the White House meeting during an NPR interview on Wednesday evening. "It's alive, and we're making progress," Ryan said of the bill. But, he added, "it's going to take a little bit of time."

Until the meeting, there was no indication that there would be a formal effort to tweak the bill before lawmakers left Washington.

The amendment before the Rules Committee would set up a federal insurance pool for those with serious and expensive medical conditions such as cancer or congestive heart failure. The fund is intended to subsidize coverage for patients with those serious preexisting conditions to lower premiums for healthier patients. Some House members, though not all, see the provision as a companion to potentially allowing states to opt out of the Affordable Care Act's ban on charging those patients higher premiums, known as "community rating."

That issue has become one of the key sticking points in House Republicans' ongoing clashes over how to repeal and replace the Affordable Care Act. While the hard-right House Freedom Caucus is insisting on at least allowing states to opt out of community rating requirements — if not repealing them entirely — moderates say they're important protections for patients.

High-risk pools, however, had gained broad support during a late Tuesday meeting that brought together Pence and other White House officials with conservative and moderate House leaders.

Adding in high-risk pools to the underlying bill doesn't guarantee House Republicans will ultimately agree on a replacement, and they are still set to leave town Thursday for their Easter recess. But the amendment represents one way leadership could ultimately reshape the bill, by incrementally modifying it until consensus is reached. Palmer and Schweikert are both Freedom Caucus members.

A Rules Committee spokeswoman confirmed the panel would meet Thursday to consider the amendment.

High-risk pools have long been a staple of conservative health-care reform plans, allowing insurers to rope off patients with exponentially higher costs from the rest of the population they insure. To fund the high-risk pools under their bill, House Republicans have proposed providing states more than $100 billion in federal "stabilization" funds.

But some high-risk pools operating before passage of the Affordable Care Act were not financially viable and Avalere Health President Dan Mendelson warned the same thing could happen again. He noted that some of the consumers who tend to end up in these groups have extremely high medical expenses, from cancer treatments to complications from HIV/AIDS.

"The amount that they've allocated seems really big," Mendelson said, referring to House leaders, "until you realize these are the train wrecks."

—-

The Washington Post's Robert Costa and Paul Kane contributed to this report.