Days before Republicans were forced to cancel a House vote on their plan to repeal and replace Obamacare in late March, the White House made a last-minute offer to woo the ultra-conservative House Freedom Caucus: eliminating the requirement that insurers cover essential health benefits, such as hospitalization and maternity care. The move would drive down costs for healthy people by letting them buy skimpier plans, but coverage for sick people (or pregnant women) would become wildly expensive — essentially making the law’s popular protections for people with preexisting conditions meaningless.
That effort failed. Freedom Caucus members were “encouraged,” but still wouldn’t support the American Health Care Act. Meanwhile, the proposal infuriated GOP moderates in the House and made the bill even less likely to pass in the Senate. (Mainly for ideological reasons, but also because you probably can’t change those Obamacare regulations through a budget-reconciliation bill.)
It was hard to see how Republicans who thought AHCA was too hard on the poor and sick, and those who wanted it to be even crueler could ever reach a compromise. But the White House continued holding negotiations.
In early April, House Republicans said they’d made progress and might pass a revised health-care bill before heading home for Easter recess. The new compromise was said to involve scrapping the essential health benefits and allowing states to opt out of the “community rating” requirement, which basically says insurers can’t charge people more if they think they’ll need pricier coverage.
That effort failed too. There was no vote, and Republicans had to answer for their health-care stance during raucous town halls.
Now, with President Trump determined to score a legislative victory by Saturday, his 100th day in office, Republicans have signaled once again that there could be a vote on a revised GOP health-care bill any day now. “I would not be the most shocked person in the building if we voted it this week out of the House,” Representative Trent Franks, a Freedom Caucus member, told the Washington Post on Tuesday.
Once again, the potential compromise involves removing protections for people with preexisting conditions — but this isn’t like the two times Republicans claimed they were on the verge of destroying Obamacare.
For starters, this time we have details on the GOP deal. According to the full legislative text obtained by the Hill, the amendment would allow states to apply for waivers to opt out of the Obamacare’s essential health benefits and its restrictions on how much more insurers can charge older people. States could also scrap the community rating, allowing insurers to charge people with preexisting conditions far more.
This would only apply to people trying to enter the individual market after a break in insurance coverage, and the states would have to participate in the Patient and State Stability Fund. The idea is that states will use that money to set up high-risk pools, but as health-law expert Tim Jost told Vox, they aren’t required to do so. “The idea was people who fall through the cracks would have a high-risk pool,” he said. “What happens though if a state uses their money for reinsurance instead?”
Similarly, the criteria for obtaining these waivers is very loose. The amendment says states must show doing away with the regulations would meet at least one goal on a list of criteria, including reducing premiums, increasing choice, and stabilizing the market. If the federal government fails to take action on the application within 60 days, the waiver will be automatically approved.
All of these changes satisfy the conservatives’ desire to deregulate the individual insurance market, and it appears the Freedom Caucus may finally be onboard. The Post reported on Tuesday night that key members Mark Meadows, Jim Jordan, and Raúl Labrador have signaled that they back the plan. Former AHCA opponents David Brat and Scott DesJarlais announced that they support the measure. “It’s pretty much everything I was looking for in terms of concessions,” DesJarlais said.
“We probably had about half of the members of the Freedom Caucus in the first go-around,” White House legislative affairs director Marc Short told reporters. “With this amendment, I’d like to think we have greater than 80 percent — we are very confident in that.”
So after weeks of negotiations, most of the Freedom Caucus is willing to back the GOP health plan — but what about the moderates?
Earlier on Tuesday, Representative Charlie Dent said he remains opposed to the plan negotiated by fellow Tuesday Group co-chair Tom MacArthur. Another GOP moderate, Representative Chris Collins, said the bill’s passage in the House isn’t really up to his group. “The key to getting this across the finish line doesn’t rest with the Tuesday Group,” Collins said. “It rests with the Freedom Caucus.”
It’s possible that the GOP can get their health-care plan out of the House with support from most of the Freedom Caucus and some of the Tuesday Group. But as Vox notes, the new plan “does nothing to address concerns about massive coverage loss” and would probably cause even more people to lose their health insurance.
At least seven GOP senators said they could not support AHCA because they were concerned that too many people would lose coverage. Republicans can still only afford to lose two votes. And a new poll found that most Americans are now against repealing and replacing Obamacare, and even more opposed to letting states opt out of certain regulations.
It seems unlikely that this version of the GOP health plan will become law, but House Republicans should keep negotiating. Maybe if they make it just a bit harder on sick people, they can get it passed by Memorial Day.