This never ends even though the likelihood of a successful “new” health care policy passing in either the House or the Senate is wishful thinking. The White House is still trying to revive its healthcare reform push with a new bill that would include popular provisions from the Affordable Care Act (ACA) but also allow states to opt out of them. Vice President Pence and other White House officials presented an idea at the Freedom Caucus meeting to allow states to choose to apply for waivers to repeal two ObamaCare regulations that conservatives argue are driving up premiums.
Those two regulations detail ObamaCare’s essential health benefits, which mandate which health services insurers must cover, and “community rating,” which prevents insurers from charging sick people higher premiums.
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.
Multiple lawmakers said the White House was hoping to have a vote as soon as this week, though Rep. Mark Meadows (R-N.C.), the Freedom Caucus chairman, cautioned against setting “artificial” deadlines. “There is no deal in principle; there is a solid idea that was offered,” Meadows told reporters after the meeting. “We’re certainly encouraged by the progress we seem to be making,” he added.
He said that repeal of the two regulations in question would provide enough yes votes to pass the bill but cautioned that the Freedom Caucus needs to review the legislative language and make sure it is adequate. Meadows said last Monday night that lawmakers who were previously opposed to the American Health Care Act have switched their position because there is currently a lack of detail.
House leadership had not taken a hands-on approach so far to the revived negotiations and as recently as last week was essentially saying the bill was dead.
There is also the question of how moderates would respond to the proposal. Centrists previously objected to adding repeal of the essential health benefits to the bill.
Rep. Chris Collins (R-N.Y.), a member of the centrist Tuesday Group, argued that giving states the choice, and making them meet certain standards in putting together a waiver application, could allay centrist concerns.
White House officials met with a group of centrists, as well as House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) earlier in the day. It’s still unclear whether the changes would pass muster under Senate rules governing a filibuster. Meadows indicated that officials are checking to at least make sure that the changes would not be “fatal” to the entire bill under the rules, though it is still possible the provisions would end up being struck out in the Senate.
While Meadows emphasized that the ban on denying coverage to people with pre-existing conditions would not be repealed, Democratic health experts point out that allowing insurers to charge sick people higher rates could effectively put coverage out of reach.
Meadows argued that a “stability fund” under the measure could subsidize higher premiums to bring down the cost for sick people. Lawmakers are also looking at better directing those $115 billion in stability fund dollars to target them toward reducing premiums.
Meadows indicated there would not be time for a Congressional Budget Office analysis of the changes if the new bill were voted on this week, which is sure to draw an outcry from some. That would mean lawmakers would not be certain of the cost or coverage effects of the bill when they voted.
Yasmeen Abutaleb and David Morgan discussed whether the House would reach healthcare deal before two-week break. Well, that isn’t going to happen and now the Congress is on Easter/Passover break. Deep divisions cut short Republican hopes for a quick revival of Obamacare replacement legislation on Wednesday, as Congress prepared to leave town for a two-week recess without a deal to end party infighting.
“We are going to go home tomorrow without a deal,” Congressman Chris Collins, a Republican moderate in the U.S. House of Representatives, told reporters last week.
A White House ally, Collins said days of negotiations had broken down over conservative demands to allow states to waive popular Obamacare policies that protect sick people from price discrimination and allow young adults to stay on their parents’ healthcare plans until age 26.
He said the hard-line conservative House Freedom Caucus was “moving the goal posts” for negotiations, risking potential support from moderate Republicans.
Both sides of the debate had warned that the Republican push for healthcare reform, one of President Donald Trump’s top campaign promises, could lose momentum if lawmakers left without a deal to bridge fissures that led to the legislation’s failure on March 24, when House Speaker Paul Ryan canceled a vote.
Earlier last Wednesday, Heritage Action Chief Executive Mike Needham told reporters his conservative group was looking at ways to target House moderates known as the Tuesday Group, with attack ads in their districts and other tactics.
But Ryan told a forum that the discussions had been “very productive” and emphasized that Republican leaders have not set a deadline for agreement. “We can keep working this for weeks now,” Ryan said. “We’ve got time to figure this out.”
Republicans have been railing against President Barack Obama’s Affordable Care Act since its enactment in 2010. On Tuesday, some Republican lawmakers expressed hope the Trump White House would unveil a healthcare bill. Some conservatives said a vote by the House was possible this week.
The legislation has not yet emerged, despite talks with Republican lawmakers led by Vice President Mike Pence. A House Republican leadership aide said on Wednesday that plans remained on track for the divided chamber to begin a more than two-week recess by mid-afternoon on Thursday.
Representative Mark Meadows, chairman of the hard-right House Freedom Caucus, late on Tuesday said, “There’s a concern on my part that if we’re making real progress, that going home sends the wrong message.”
Meadows told reporters on Wednesday he had not yet heard from the White House about timing of the next negotiation session. Still, the negotiations will allow lawmakers to return to their home districts and tell voters they are trying to deliver on a campaign promise that helped them win election.
In an interview with Axios and NBC television, House Majority Leader Kevin McCarthy said Republicans will produce a healthcare bill, but did not provide a timetable.
Late last Tuesday, following a closed-door meeting with House Republicans, Pence told reporters there was “good talk, good progress” toward a bill. He did not elaborate. Republican lawmakers said that efforts are now focused on maintaining Obamacare’s essential health benefits, such as mental health coverage and maternity care. But states could apply for waivers if they could improve coverage and reduce costs. If major portions of Obamacare are repealed, there were discussions of creating a “backstop” so premiums do not spike for people with chronic illnesses in high-risk insurance pools.
Rob Garver was correct when he stated that the new Obamacare Repeal Plan would leave the hard decisions to the States, as Rep. Collins pointed out. It can be hard to know which of President Trump’s tweets to take seriously sometimes, but evidently, his claim that the White House and Republicans in Congress are still working on health care reform after last month’s debacle with the American Health Care Act was true. According to The Washington Post, the White House is pressing an alternative version of the bill in an effort to win over both the hard right Freedom Caucus and the more moderate elements of the party, which combined to block a vote on the AHCA in March.
House Republicans found themselves in a bind weeks ago when President Trump was demanding they vote to pass the extremely unpopular AHCA, a bill that had the support of about 17 percent of the country according to public opinion polls. It was unpopular largely because it would result in some 24 million Americans to be without health insurance within a decade — 14 million by choice — and would dramatically drive up costs for older Americans and the poor.
The Freedom Caucus was upset that the bill didn’t go far enough, demanding a rollback of multiple elements of the ACA that the bill didn’t touch, such as requirements that insurers not discriminate against people with pre-existing conditions and that they offer a suite of “essential” health benefits with every plan and more. Their object, above all, was to drive down the cost of insurance premiums.
House moderates, at the same time, were balking at the changes already in the AHCA, concerned that many fewer Americans would be insured and that costs would skyrocket for the poor and older Americans who were not yet eligible for Medicare.
The version of the bill now being considered would not solve those problems so much as avoid them. The plan would be to push decisions about issues like essential benefits and coverage requirements, again, down to the state level.
For example, the proposal would allow states to drop the “community rating” requirement of the ACA, which demands that insurers charge the same amount for coverage for people who are the same age. In effect, this is a backdoor way of eliminating the ACA’s ban on discriminating against people with pre-existing conditions. While insurers would still be nominally required to offer policies to people with existing illnesses, there would be no limit on what they could charge them. Just as it was in the days before the ACA, sick people would be effectively priced out of the market for health insurance.
Similarly, the proposal would allow states to eliminate the ACA’s requirement that insurance policies purchased with government subsidies cover a set of standard benefits, including hospital stays, outpatient procedures, addiction and mental health treatment, maternity care, and more. The new plan would allow states to create a system in which people could use federal dollars to buy insurance plans that offer far less protection from health-related costs than the ACA requires.
This last move would create at least the possibility that states could achieve one of the key goals articulated by members of the Freedom Caucus: driving down average health insurance premiums. But it would do so in the same way that removing the requirement that new cars have brakes and airbags would make automobiles more affordable.
The hope among supporters of the plan is that by allowing the sale of bare-bones policies, the change would reduce the number of people who lose coverage under the new rules. However, it’s not clear that the Congressional Budget Office and the Congressional Joint Committee on Taxation would be willing to play ball when they score the bill. Last year, the CBO made it plain that for purposes of analyzing the effects of healthcare legislation, it would not consider people “covered” by insurance unless they were substantially protected from major financial risks.
The upside of this plan, from the perspective of the White House and Congressional Republicans, is that it would allow them to claim that they have kept their promise to repeal and replace the Affordable Care Act while avoiding the hard work of crafting a measure that solves the thorny problems that repealing the bill creates.
As with the original version of the AHCA, Republicans in the House can’t count on getting any Democratic votes for this iteration of the ACA replacement plan. So, assuming the changes are sufficient to win over the Freedom Caucus, the big question is the reaction of the more moderate members of the Republican conference.
Will the fig leaf of devolving key decisions to the states be enough political cover, or will the latest attempt to repeal the ACA cause another fracture in the party, albeit along a different fault line?
One doctor interviewed stated that when it comes to healthcare, Republicans need to take a Hippocratic Oath to do no harm and I wholeheartedly agree.
When we become a doctor, most of us spend time in an emergency room that admits and treats the kind of hard-working, low-income working families. For many of them, the ER was their first and last resort after avoiding the doctor for years because they had no health insurance.
We didn’t check a patient’s political affiliation before treating them. We didn’t check the party affiliation of the other doctors and nurses, either, and they didn’t ask us for ours. Rather, we worked together as a team, following through on the Hippocratic Oath we had taken to treat patients to the best of our ability and, above all, to “do no harm.”
We have treated patients before the passage of the Affordable Care Act, and treated patients after, just as the legislation was beginning to take effect. We noticed firsthand that many patients stopped fearing the cost of their ER visit as more were covered by health insurance. When they pulled out their insurance cards, we could tell they felt peace of mind.
If only politicians were required to take an oath to do no harm. Since gaining a majority in Congress, most Republicans have been actively working to bleed the ACA dry so that it will fail, thereby fulfilling their own prophecy. They voted repeatedly to repeal the law and sued to stop it in court. Now that they have full control of government, they’re trying to sabotage it.
After Republicans pulled Trumpcare from the House floor last month, President Trump responded with a blame-filled diatribe in the Oval Office — 10 minutes of finger-pointing in which he offered up the cynical hope that our healthcare system will “explode.” The president of the United States actually stated that letting the healthcare system “explode” was “the best thing we can do politically speaking.”
It still seems that the Republicans aren’t interested in improving the ACA; they’d rather attack it for political gain. More recently, the Trump administration has stopped promoting the open-enrollment period for health insurance plans, a move that is now being investigated by the Office of Inspector General in the Department of Health and Human Services. The idea, apparently, is that if people don’t know by what date they need to sign up for a plan, they won’t enroll, fewer people overall will be covered, premiums will rise for everyone else, and the administration will have even more grounds for saying the ACA doesn’t work.
Coupled with the absurd failure of Trumpcare, these deliberately destructive moves lay bare what many of us suspected all along — the Republicans aren’t interested in improving the ACA; they’d rather attack it for political gain. Trump and the Republican leadership have been fundamentally dishonest to the American people for the purposes of winning votes and securing power. This is exactly what disgusts voters about Washington. With the right wing up in arms over their failure to repeal the ACA, Republicans are sure to try again. But they seem to have learned no lessons from their first attempt. They continue to show no intention of reaching across the aisle to work on commonsense solutions.
According to some policy experts, the Trump administration could immediately reduce the size of deductibles and other healthcare costs for low-income Americans by permanently funding cost-sharing reductions — federally subsidized discounts that Republicans have filed lawsuits to prevent. Republicans could also instantly repair the ACA’s risk corridor provision, a program that helped insurers to share risk and offset losses, and which Republicans effectively undid in 2014, driving dozens of insurers out of the marketplace. Unfortunately for the American people, Trump has made it clear that these solutions are not in his political interest.
To the White House and Republican leadership: When are you going to get it? Even after years of attacks and sabotage, surveys are telling us Americans want the Affordable Care Act. But they want it to work, and they want Republicans and Democrats to work together to make it better.
I address you, the politicians, especially the GOP, who are doing real harm to real people for your own political gain. You’ve undercut the ACA every step of the way and now you own it. You claim you want a healthcare system that covers more people and reduces costs, and that’s what Democrats have been working to achieve. When you’re ready to get serious, take an oath to do no harm and quit the sabotage and partisan games. Only then can we work together to help people and remember the principles that I have already laid out for a health care system that would benefit us all.