When intra-party negotiations collapsed and the GOP healthcare bill was pulled from the floor late last month, many political observers saw that development as a coup de grace. Obamacare "repeal and replace" was, for all intents and purposes, dead. Republicans insisted that they were committed to keeping discussions alive and "getting it right," but conservatives and liberals alike wondered if such rhetoric was merely face-saving spin. Evidently not. According to multiple reports, Vice President Mike Pence has been spearheading an intensive behind-the-scenes effort to woo recalcitrant House Freedom Caucus members and bring them into the fray with policy compromises:
Pence et al gave verbal proposal to HFC, which is waiting to see text in next 24 hours lawmakers say— Peter Sullivan (@PeterSullivan4) April 4, 2017
Mark Meadows says they're waiting for legislative text, but there is still no deal even in principle.— Matt Fuller (@MEPFuller) April 4, 2017
The general time frame here would be to strike an agreement prior to the April recess, then return in May to pass the amended legislation, before the first of two 2017 reconciliation packages expires with the passage of a new budget resolution. In-person negotiation and lobbying is still ongoing:
Members I've talked to have indicated the potential timeline on renewed health care negotiations is to get a deal before recess, vote after— Haley Byrd (@byrdinator) April 3, 2017
What does the would-be compromise entail? That's still coming together -- and Paul Ryan emphasized repeatedly this morning that talks are still "conceptual" in nature -- but here's the general gist, according to the Washington Examiner:
The compromise would allow states to opt out of forcing insurers to cover 10 essential health benefits in plans, including maternity care and hospitalization. The states could also opt out of forcing insurers to comply with a community rating mandate, which today requires them to offer the same rate to an entire geographic area, and bars them from charging sicker people much more. But the states would have to get a waiver to opt out of either regulation, and it remains unclear what that waiver would entail...Meadows added that the mandates for insurers to cover people with preexisting conditions and letting kids stay on parents' plan until 26 years of age will remain in place. However, the community rating mandate was a key driver for ensuring coverage for people with preexisting conditions. Without the mandate, insurers could charge people with preexisting conditions exorbitantly high prices, making coverage hard to achieve. A community rating, which forces insurers to charge the same rate throughout a geographic area, would ensure that insurers couldn't charge a person with preexisting conditions [vastly higher rates].
Even if this is sufficient to bring the Freedom Caucus on side, it could drive away moderates. As the story explains, eliminating the "community rating" mandate could render the still-included "pre-existing conditions" requirement effectively useless. Sure, we'll insure you as required, providers could tell sick people; here's a massive monthly bill. Supporters of the waiver could argue in response that no state would not be forced to seek that waiver, that there's no questioning that at least loosening those requirements would definitely drive down premiums for many other consumers, and that there's a $115 billion fund allocated in the legislation that's explicitly earmarked to help the "high risk" consumers who'd be hardest hit by the community rating mandate being weakened or wiped out. Nevertheless, I'd guess that significantly undermining community rating will be a very tough sell to a lot of GOP rank-and-file members, virtually all of whom promised that any Republican plan would maintain protections for people with pre-existing conditions. Plus, large additional injections into the 'stability fund' may cause Freedom Caucus fiscal hawks to waver. Philip Klein, who was a conservative opponent of the original failed version of the American Health Care Act, sounds more hopeful about this iteration. He notes that updates would be added to the previous legislation, as opposed to starting the whole process over, and asks a series of questions as we await more details. This is a key one:
How much do the changes depend on permanently having a conservative as Secretary of Health and Human Services? Secretary Tom Price, as an opponent of Obamacare, would presumably be willing to issue such waivers. But if the regulations remain on the books, it also could mean that when a Democrat eventually wins the White House, a future liberal secretary of HHS may be able to rescind the waivers, and thus re-impose Obamacare's regulatory regime with the stroke of a pen.
Good point. Meanwhile, some in the media are chuckling that Republicans are seeking to revive a bill that polled so poorly, to which there are three replies: First, repealing and replacing Obamacare was the core campaign promise of the Republican party for four straight elections. Not returning to the table would be an astounding betrayal and abdication. Second, a significant part of the reason that the AHCA was so unpopular is that many conservatives opposed it as insufficiently aggressive. In this recent poll, the sum of respondents who either supported the bill or opposed it for not repealing enough of Obamacare exceeded those who opposed it because it changed too much. Finally, the Obamacare status quo is still failing, and getting worse. We told you about the extremely significant Anthem development last week, and now there's this bulletin out of Iowa:
Iowa’s dominant health insurance company has decided to quit selling individual policies because of tumult in the market stemming from the Affordable Care Act and Republicans’ failed effort to replace it. Wellmark Blue Cross & Blue Shield’s decision means more than 21,000 Iowans who bought health insurance policies from the company in the past three years will need to find another carrier — and it’s not clear all of those people will have another choice. Wellmark President John Forsyth said his company's decision was painful but necessary, because the carrier had lost $90 million over three years covering that group of people.If Obamacare stays in place, millions of consumers will continue to be battered with higher costs, fewer options, and less access to care. Public opinion data has demonstrated for years that more people have been harmed by the law than helped by it. I'll leave you with Ryan avoiding details and any rigid timeline like the plague this morning: