With the end of President Trump’s first 100 days fast approaching, House Republicans appear ready to take another stab at reviving an Obamacare repeal bill that was pulled from the House floor last month due to lack of support and has since has been the focus of several rounds of unsuccessful negotiations.
The latest compromise was worked out between Rep. Mark Meadows (R-NC), chair of the hard-right House Freedom Caucus Chair, and Rep. Tom MacArthur (R-NJ), who co-chairs the GOP centrist wing, the Tuesday Group, the Huffington Post reported. It would allow states to opt out of various Obamacare insurer mandates. To receive waivers, states would have to prove that their programs would “reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions,” according to a white paper outlining the amendment surfaced by Politico. States also would only be able to opt out of Obamacare’s community ratings standards – which prevent insurers from jacking up premiums based on health status – if they set-up a high-risk pool or participate in a federal high risk pool.
From a policy standpoint, the amendment would take the individual health insurance back to the pre-Obamacare days, where insurers could discriminate against consumer on the basis of their health status. If amended as proposed, the GOP bill would technically keep Obamacare’s ban on denial of coverage based pre-existing conditions on the books. But by making the community ratings standards optional for states, insurers could still price sick consumers out of affording insurance. The high-risk pools states set-up to capture some of these consumers would be drastically underfunded if the current funding for them in the bill goes unchanged and it’s likely that states will impose waiting periods, high-deductibles, exclusions of certain coverage areas and other obstacles on consumers to keep costs low for their high risk pools.
From a political standpoint, it’s unclear whether the proposal moves the dial on getting Republicans the 216 votes they would need in the House to pass the bill. Moderates have been deeply skeptical of the legislation’s massive cuts to Medicaid, which would remain in this proposed version. As members began discussing a state opt-out idea before the Easter recess, some conservative complained it was still too much of an infringement on states’ rights to require them to go through a waiver process.
Rank-and-file has also spent the last two weeks at town halls where they were berated by constituents over their efforts to repeal Obamacare.
Nevertheless, the proposal appears to have the blessing of GOP House leadership, which is a change from the hands-off approach leadership took in the other recent rounds of negotiations. Speaker Paul Ryan (R-WI) is expected to discuss the proposal on a conference-wide conference call Saturday, CNBC reported.
As Republicans contemplate this latest change to the failed bill when they return from recess next week, lawmakers will also be rushing to pass a government funding bill to avoid a government shutdown at the end of the month.