Since President Donald Trump and House Speaker Paul Ryan (R-Wis.) failed spectacularly last month to pass a long-promised healthcare bill that would repeal and replace the Affordable Care Act (ACA), progressive voices have urged politicians to solve the problems of rising premiums and unequal access to care with nationwide Medicare-for-All.
But the Trump administration is taking the opposite approach, as it tries to revive its dead healthcare bill with even crueler legislation: Late Monday, Vice President Mike Pence and other White House officials proposed a harsher healthcare law to the far-right Congressional Freedom Caucus, in an attempt to garner their support for a new bill.
The White House proposed allowing states to apply for waivers to jettison two core Obamacare regulations. Those regulations require insurance companies to cover essential health benefits (EHBs), which includes coverage for pre-existing conditions, and also prevent insurers from charging sick people higher premiums.
The Hill reports:
Conservatives had previously called for the bill to repeal those regulations outright, but the deal now being discussed would give states a choice by allowing them to apply for a waiver from the federal government.
Freedom Caucus members expressed openness to the proposal but cautioned that they need to review the legislative text, which they hoped would be available within the next 24 hours.
"To pass the House, any bill would need to find favor not just with the Freedom Caucus, but also with more moderate Republicans," observes the New York Times' Margot Sanger-Katz. "It would also need to attract the support of nearly every Republican in the Senate to become law."
The impasse between so-called moderate Republicans and the far-right Freedom Caucus caused the Republicans' initial bill, the American Healthcare Act (AHCA), to implode last month in the House of Representatives without coming to a vote.
"Appeasing the most extreme members of House in order to buy votes will not help American families and other health care consumers," argues healthcare advocacy group Families USA. "The last fight over health care repeal made it clear that people want quality, affordable health care and that the health care plans of the Trump administration and Republican House don't fit the bill. Nothing has changed. It's time to move on."
Indeed, the White House proposal would be extremely unpopular with voters, observers say. Illustrating the point, Sanger-Katz points out that "[i]f both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up."
There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care—or even any cancer patients—would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.
In addition to that critique, a new report (pdf) from the Center on Budget and Policy Priorities (CBPP) suggests that the AHCA would drive up premium costs for everyone.
"Not only would enacting the AHCA shrink enrollment and raise per-enrollee costs in the individual market in 2018, the possibility of enactment will lead insurers to propose higher rates than they otherwise would, and it could discourage them from offering plans in the individual market at all," writes CBPP. "As a result, Republican leaders' refusal to foreclose bringing some version of the AHCA to a vote will impose tangible costs on individual market consumers."
In fact, Republican leaders appear all the more committed to bringing a new version of the AHCA to vote. Ryan is supporting the new talks between the White House and the Freedom Caucus, reports ABC, although the House Speaker wouldn't lay out a timeline for a vote.
"We're throwing around concepts to improve the bill," Ryan told ABC. "That's occurring right now, but that is not to say that we are ready to go. Because we want to make sure that when we go, we have the votes to pass this bill."
If the AHCA—or an even harsher version—passes, the result will almost certainly spell doom for Republicans, many argue. Rep. Ted Lieu (D-Calif.) tweeted that if the measure passes, Democrats are almost certain to take back the House:
— Ted Lieu (@tedlieu) April 4, 2017