WASHINGTON - Key Republicans kept hopes alive Monday for a breakthrough on stalled health-care legislation, days after President Donald Trump launched a remarkable intraparty attack on the hard-line conservatives who have blocked the effort.
Vice President Mike Pence, Chief of Staff Reince Priebus and Budget Director Mick Mulvaney came to Capitol Hill late Monday to attend a meeting of the hard-right House Freedom Caucus, hours after hosting members of the moderate Tuesday Group at the White House for a health-care focused discussion.
Rep. Mark Meadows, R-N.C., the chairman of the Freedom Caucus, told reporters afterward that the administration officials offered a "solid idea" that could form the basis of an intraparty compromise.
That idea, he said, would allow states to apply for federal waivers exempting them from some health insurance mandates established under the Affordable Care Act - including "essential health benefits" requiring coverage of mental health care, substance abuse treatment, maternity care, prescription drugs and more, as well as a provision that bars insurers from charging the sick more than the healthy.
"We're certainly encouraged by the progress that we seem to be making," Meadows said, though he cautioned reporters that no legislation had yet been drafted reflecting the proposal and that there was no deal in place to modify and proceed with the bill that was pulled from the House floor last month.
But the flurry of activity on Monday from the White House officials and top House Republicans reflected an ongoing willingness to wrestle with the difficulties of winning a GOP consensus on health care - an issue that helped drive much of the party's electoral gains over the past eight years since the Affordable Care Act was passed.
It remained unclear whether moderate Republicans could swallow the proposals on offer Monday. Similar changes were presented on Monday to Tuesday Group members at the White House, to a warm, if cautious, reception.
Two attendees of the White House session said afterward that they were optimistic, but not certain, that an intra-GOP accord could be reached.
"Anything's possible," said Rep. Tom MacArthur, R-N.J., a co-chairman of the Tuesday Group. "I'm not saying I think it'll happen - I don't know - but I think it's possible."
A major sticking point could be allowing insurers to vary their prices according to a person's health - a Freedom Caucus demand that was rejected last month and helped stall the bill.
The Affordable Care Act instituted a "community rating" requirement for insurers - meaning that they could not segregate healthy subscribers from sick ones and charge the latter higher prices. Instead, insurers can only vary their prices based on age, geographical area and tobacco use, allowing the premiums paid by the healthy to subsidize the sick.
But many conservatives argue the community rating requirement has driven up premiums too high for healthy individuals and should be rolled back. Many GOP lawmakers, however, fear doing so could make insurance unaffordable to the sick and would represent a betrayal of pledges made by Trump and congressional leaders not to discriminate against those with pre-existing medical conditions.
Rep. Chris Collins, R-N.Y., who attended the Tuesday Group meeting, said discussions about community rating waivers were "to be continued" but said other policy provisions discussed could get moderates on board with the bill.
The previous version of the bill gave states the choice whether to keep the essential health benefit mandates. Creating a system where the states could apply for a waiver that would be reviewed by the Department of Health and Human Services could convince some to sign on, he said, as well as more state aid to subsidize coverage for the very sick.
Trump took aim at the Freedom Caucus in a series of tweets Thursday, pledging to "fight them" at the polls in the 2018 midterms. The move appeared to be a last-ditch attempt to jolt the hard-liners into supporting the Trump-backed American Health Care Act, which was pulled from the House last month.
Trump remained active on Twitter over the weekend, suggesting the situation was still fluid - and that he is looking at way to move forward with the help of either moderate Democrats or conservative Republicans.
He also played a round of golf Sunday with Sen. Rand Paul, R-Ky., the libertarian-oriented former presidential candidate who has been a sharp critic of the House bill and praised its failure less than two weeks prior.
On Monday, Paul summoned reporters to his office and positioned himself as a potential broker of a compromise, floating a proposal that he suggested could win broad GOP support.
"If conservatives want 100 percent repeal, let's say moderates want 80 percent repeal," he said. "Let's vote on 90 percent repeal, and be done with it."
With Congress heading into a two-week recess at the end of the week and Trump meeting this week with three foreign leaders, there was little expectation within the White House earlier Monday that there would be significant movement on a health-care bill in coming days. But several key players on the Hill and at the White House said that talks have progressed.
"It's on the back burner, but the boil is still going," said a senior administration official familiar with the Trump administration's strategy, who requested anonymity to speak more candidly.
The official characterized Trump's Sunday golf outing with Paul as an opportunity to kick around ideas for moving forward. Trump also brought Mulvaney, a former House Freedom Caucus member, for the outing at Trump National Golf Club in Sterling, Virginia.
"We continue to feel optimistic in the sense that there's a lot of constructive ideas that are coming to the table to get us to a way forward," White House press secretary Sean Spicer told reporters Monday, adding that Trump "has made clear that he intends to work with anyone who wants to help him get to the number of votes."
On Sunday, Trump told his followers that "Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck."
In another tweet, Trump declared: "Anybody (especially Fake News media) who thinks that Repeal and Replace of ObamaCare is dead does not know the love and strength in R Party!"
Trump aides said such tweets are intended partly to keep the conversation about health care going, in hopes of achieving enough consensus to move forward. A senior White House official acknowledged Monday that lawmakers have yet to coalesce around a particular proposal.
"It's more of a sentiment than a policy people can hang their hat on right now," said the official, who requested anonymity to speak more candidly about the state of play. "There are a lot of people who were disappointed in how it ended and collectively think we can do better."
"Some of this has to be Congress taking the lead and putting this back together," the official added.
But Pence's meetings with lawmakers Monday indicate that the Trump administration continues to play a central role in trying to broker a compromise between conservatives and moderates on Capitol Hill.
"We're just talking," Priebus told reporters as he left the Freedom Caucus meeting with Pence after about 45 minutes.
Several Freedom Caucus members said afterward that they were newly optimistic that a deal could be struck.
"It's progress, and it's promising," said Rep. Scott DesJarlais, R-Tenn. But he said the group was waiting to see the administration's proposals put in writing.
"We're anxious to see the legislative text," he said, adding that it would be "a stretch" for the House to pass the bill before week's end.