After GOP Strikes Weak Government Funding Deal with Democrats, They'd Better Not Blow It on Obamacare

Posted: May 01, 2017 1:05 PM
Senior administration sources are sounding confident that the House will finally vote to repeal and replace President Obama's failing health law this week, the White House Chief of Staff is talking up that same timetable, and the president himself expressed a hedged hope that House Republicans will round up the votes and advance the American Health Care Act before the week is out. But leadership sources on Capitol Hill have been lowering expectations; private, soft whip counts have failed to hit the magic number, they say, and top GOP brass is loathe to set up a re-run of the March debacle.  At issue is winning over enough moderate members of the conference to clear the simple majority mark, now that most of the House Freedom Caucus has endorsed a compromise amendment.  Is Team Trump this bullish for a reason, or are they raising expectations as a form of pressure?

One of the concerns GOP centrists have raised is whether the bill would provide adequate protections for people with pre-existing conditions. President Trump says he 'guarantees' that it does, but some members aren't so sure. The AHCA requires insurers to take on consumers with pre-existing conditions, but the new amendment would give states the option to seek waivers from a closely-related mandate called "community rating," under which carriers cannot charge those customers higher rates. This requirement helps sick Americans obtain coverage with a comparable price tag, but also drives up premiums across the board. Is this impasse irreconcilable? National Review's  Ramesh Ponnuru suggests that moderates who are inclined to reject the bill over pre-existing condition-related worries are missing some key points. He disputes the false assumption among many legislators and journalists that "community rating" waivers would return consumers with pre-existing conditions to the pre-obamacare days of few protections and often-faulty high risk pools:

People with preexisting conditions would have several protections that were not in place before Obamacare. States would be able to waive Obamacare rules on preexisting conditions only for people who do not maintain insurance coverage. If you are someone with one of those conditions who has gotten coverage through Obamacare (or otherwise gotten coverage), the Obamacare regulations will still apply: In no state will it be possible for an insurance company to charge you more than a person without such a condition. If you are someone who has insurance and develops one of these conditions, you too will be covered by the Obamacare regulations. Insurers will not be able to charge you extra, either, under any waiver. And maintaining insurance coverage will be easier than it was pre-Obamacare, because people without access to Medicare, Medicaid, or employer coverage will have a tax credit to purchase insurance on the individual market. So the only people who might be adversely affected by a waiver of the Obamacare rules — if a state applied for one — would be those who have a preexisting condition but have not used their credit to buy insurance. And even they would have to have access to a high-risk pool for the regulations to be waived. People with preexisting conditions, then, would have a triple safety net even in a state that took maximum use of the waivers: Tax credits, regulatory protection contingent on continuous coverage, and high-risk pools would all benefit them.

The 'continuous coverage' protection is an important one: Anybody who follows the law's incentive structure and maintains insurance cannot be charged more down the road for a pre-existing condition (previously-uninsured healthy people who try to sign up for coverage under the law would have to pay a 30 percent surcharge in year one, designed to guard against free riding). As Ponnuru says, the only subset of people who might be at risk from potential waivers are uninsured people in the individual market who haven't obtained insurance, and who choose not to do so when offered an AHCA tax credit -- and even then, they'd have access to a high risk pool if and when they come knocking. The Republican bill allocates $115 billion toward these pools and patient stability funds. The Weekly Standard also tries to clear up some of the misplaced or misunderstood fears related to the treatment of consumers with pre-existing conditions, laboring to unpack President Trump's somewhat messy statements on these issues over the weekend:

Meanwhile, the always-thoughtful Avik Roy is urging the Senate to craft its own plan, regardless of what the House may be up to.  Meanwhile, Republicans at both ends of Capitol Hill ought to ponder how their base will react if they drop the ball on healthcare.  Between that choke job and the new government funding compromise with Democrats -- under which Planned Parenthood and sanctuary cities are fully funded, but Trump's wall is not -- Republican voters might wonder what the point of winning elections is.  For what it's worth, here's Speaker Ryan's memo defending the spending measure.  The biggest conservative 'wins' are an increase in defense spending (a Trump campaign promise) and boosting funding on border security:

The Hyde Amendment and DC scholarship program are nice, but they merely maintain the existing status quo. In any case, the spending arrow is pointed up.

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