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The House Freedom Caucus, a group of hard-line conservatives who were instrumental in blocking President Trump’s plan to repeal the Affordable Care Act last month, gave its approval Wednesday to a new, more conservative version, breathing new life into Republican efforts to replace President Barack Obama’s health law. (Steinhauer and Pear, 4/26)

The changes would let states escape a requirement under President Barack Obama's health care law that insurers charge healthy and seriously ill customers the same rates. They could also be exempted from Obama's mandate that insurers cover a list of services like maternity care, and from its bar against charging older customers more than triple their rates for younger ones. (Fram, 4/26)

Under MacArthur’s proposal, waivers could be granted only to states that participate in a proposed $115 billion risk-sharing pool to help pay medical costs for people with costly pre-existing conditions. (Pugh and Clark, 4/26)

"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 healthcare costs," the Freedom Caucus said in a statement. "We look forward to working with our Senate colleagues to improve the bill. Our work will continue until we fully repeal Obamacare." (Marcos, 4/26)

With Democrats firmly opposed to the legislation, pressure to support the bill is now on Republican centrists. Ensuring protections for people with pre-existing conditions remained a key concern for some. Rep. Mike Coffman (R., Colo.), who had previously backed the bill, said he was now undecided.“What I’ve got to do is to make sure people are protected in terms of pre-existing conditions and I’m not there yet,” he said. The bill retains deep cuts to Medicaid and other elements of the original proposal that concerned centrist GOP members who worried too many people would lose coverage. Many of the centrist Republicans who had been opposed to the bill last month said their position had not shifted, among them GOP Reps. Jeff Denham of California, Dan Donovan of New York and Leonard Lance of New Jersey. (Armour, Peterson and Hackman, 4/27)

Many moderates have expressed concerns in the past about changes that would eliminate the protections for individuals with pre-existing conditions that are at the center of the 2010 health care law (PL 111-148, PL 111-152). The MacArthur-Meadows amendment would let states apply for waivers from some of those protections, like the requirement that everyone be charged the same price. The amendment would keep a requirement that insurers offer coverage to people with pre-existing conditions, and consumers who maintained continuous coverage would also be protected. Dent said he feels the latest proposal "is simply a matter of blame shifting and face saving."(Mershon and McPherson, 4/26)

Senior House Republican sources said they still didn’t have the votes for passage Wednesday evening. But GOP leaders felt bullish enough about their progress that they began considering a vote as early as this week. Nothing is scheduled. However, Republicans on Wednesday — through an obscure House rule for another piece of legislation — gave themselves same-day authority to fast-track any bill at the last minute, through Saturday. (Cheney and Bade, 4/26)

Shortly after his amendment received an endorsement from the conservative House Freedom Caucus, U.S. Rep. Tom MacArthur said Wednesday he was “cautiously optimistic” the changes he’s negotiated to revive the House GOP Obamacare replacement plan could soon become a reality. “I don’t think the issue was ever needing to move moderates from no to yes,” MacArthur, who represents the 3rd Congressional District, told POLITICO New Jersey in a phone interview. “We gained some votes from the Freedom Caucus and that’s helpful, extremely helpful. I think we now need to make sure we hold the people that were yes before. And if we do, I’m cautiously optimistic we can get this done.” (Jennings, 4/26)

House Republicans have been under intense pressure to deliver on years of promises to repeal Obamacare, but GOP leaders weren’t making predictions of an imminent vote despite the pressure from the White House. (Edgerton and House, 4/26)

The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured. The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate. (Kim and Everett, 4/27)

House Republicans have an updated bill to repeal and replace ObamaCare, and The Hill has a new whip list. The updated bill includes an amendment that would allow states to opt out of key ObamaCare rules, including on minimum coverage requirements and allowing insurers to charge more based on individuals' health. (4/26)

Two influential conservative groups that opposed the GOP's original ObamaCare repeal-and-replace plan will now support the latest version of it. Club for Growth and FreedomWorks on Wednesday announced their support for the American Health Care Act after seeing proposed text of an amendment that would make conservative changes to the bill. The amendment, drafted by Rep. Tom MacArthur (R-N.J.) of the moderate Tuesday Group and Rep. Mark Meadows (R-N.C.) of the conservative Freedom Caucus, would allow states to waiver out of some ObamaCare regulations. (Hellmann, 4/26)