Republicans, under heavy pressure from the White House, are inching closer to passing a bill to repeal and replace parts of the Affordable Care Act, but possible revisions released Thursday may not clinch a deal. . . .
Yet House Republican leaders are playing down the likelihood that changes to the GOP health-care measure proposed by moderate Rep. Tom MacArthur (R-N.J.) would win over enough conservative and moderate holdouts, who have butted heads over removing some of the Affordable Care Act’s key insurance regulations.
“The question is whether it can get 216 votes in the House, and the answer isn’t clear at this time,” a senior GOP aide said. “There is no legislative text and, therefore, no agreement to do a whip count on.”
If this sounds half-baked, it is. Recall that last time the House leadership tried to ram through a bill without full committee consideration or even so much as a Congressional Budget Office scoring, it flopped. The idea is to fiddle with the previous bill by giving moderates and Freedom Caucus members each a little something:
MacArthur is trying to shore up moderate support for the bill with his amendment, which would reinstate the health-care law’s “essential health benefits,” a list of federally mandated health services that marketplace plans must cover. The GOP measure as it stands would instead allow states to spell out essential health benefits.
The amendment may also appeal to conservatives in the House Freedom Caucus because it would give states a way to opt out of some insurance regulations. With special permission from the federal government, states could write their own essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients.
The GOP 2.0 version of the American Health Care Act has about as much appeal as the original AHCA, or maybe less. It’s still a big tax cut for the rich, a hit to pocketbooks of older and more rural voters, and less generous than what recipients had received under Obamacare. Would a moderate in a district Hillary Clinton carried overwhelmingly go for this? It’d be a high-risk proposition. Would a conservative who sees more regulation (the essential benefits) going back into the deal be thrilled? Probably not. Moreover, it’s clear the Senate would reject the bill, because moderates previously said they’d refuse to go along with a Medicaid rollback.
The list of people who would not like it is long: right-wing activists; Republicans in swing districts; every Democrat; Karen Handel (the GOP candidate in the Georgia 6th Congressional District runoff election), who’d have to take a position on a cruddy bill; doctors; hospitals; and the AARP.
If you don’t feel like this makes a lot of sense, you’re not alone. Drew Altman of the Kaiser Family Foundation writes, “The president doesn’t have strong convictions himself about future directions for health care. But health policy is not like real estate. The partisan divide in health policy is grounded in deeply felt differences on both sides over policy and principle. It’s hard to see Trump’s approach to deal making working very often in health.” He may not care about the details, in other words, but plenty of people do. His threat to wreck Obamacare is utterly ineffective since Democrats may “calculate, for example, that the administration will own the fallout for a collapse in the marketplaces, as polls are starting to suggest they will. Lawmakers are also hard to threaten because most come from safe political districts. . . . and they have been getting safer and more polarized.”
Given that AHCA 1.0 was hugely unpopular and rotten from a policy standpoint, it is far from clear Republicans want to give the latest iteration a try.