It seemed on Wednesday afternoon that Capitol Hill Republicans had resigned themselves to pausing their effort to repeal the Affordable Care Act until after the two-week April recess—promising to conduct a “slow and deliberate process.”
“Obamacare took a year to get done,” Rep. Pat Tiberi (R-OH) told reporters. “I think expectations were put too high in terms of how quickly this could happen.”
But that did not satisfy the Trump administration, which reportedly demanded Congress move the ball forward before leaving Washington. That prompted the House Rules Committee to throw together a last-minute markup of a newly unveiled amendment that would funnel people with illnesses and disabilities into high-risk pools run by the states and subsidized by federal dollars.
Members of the hardline House Freedom Caucus and the moderate Tuesday Group packed onto the stage in one of the Capitol press galleries Thursday morning as a show of unity around this new amendment, calling it “real progress” that “brings us closer to the agreement we all want to achieve.”
But, to be clear, there is no agreement on the bill as a whole, which House Republicans yanked from the floor two weeks ago when it became clear it had no hope of passage.
A flurry of meetings this week between the Freedom Caucus, the Tuesday Group and White House officials failed to produce a path forward—as conservatives insisted on allowing states to waive key Obamacare cost protections for people with pre-existing conditions, a step some Republican leaders are calling a “bridge too far.”
“While we have work to do to get all the way there, we have made some real progress this week,” House Speaker Paul Ryan (R-WI) insisted Thursday, flanked by people who had already agreed to vote yes on the original bill. “The consequences are too dire for us to just give up.”
The amendment rushed through the House Rules Committee Thursday—on a party line vote after less than two hours of debate—allows individual market insurers to funnel people with serious illnesses and other pre-existing conditions into something resembling high-risk pools, which they argue will lower premiums for everyone else. They then allocate $15 billion over a 10-year period to subsidize what they’re calling this “Federal Invisible Risk Sharing Program”—an amount Rep. Alcee Hastings (D-FL) called “chump change” during the Rules Committee Hearing.
It’s essentially a far skimpier version of what exists under Obamacare, which allocated about $8 billion per year for a reinsurance program that subsidizes insurers for their coverage of high-risk individuals. Even conservative economists estimate that a system for covering people with pre-existing conditions with high-risk pools could require as much as $20 billion a year in federal subsidies, just to cover about 4 million people on the individual market. Other studies peg the cost at more than $170 billion per year.
Still, the co-author of the amendment, Rep. David Schweikert (R-AZ), insisted to reporters Thursday that these estimates are overblown.
“I don’t think it’s going to cost anywhere near $15 [billion],” he told TPM. “Remember, we’re only talking about the individual market. In my district, that’s only 2 percent of the population.”
Other lawmakers praised the proposal’s potential to bring down insurance premiums on the individual market by taking high-cost sick people out of the equation and funneling them to the high risk pools.
“What this does is simply going to the heart of taking care of those with pre-existing conditions but also working to bend the cost curve down,” Rep. Doug Collins (R-GA) told TPM.
Rep. Gary Palmer (R-AL), the other co-author of the proposal, said it would start bringing costs down drastically as early as next year—if the bill can make it through Congress.
Research associate David Anderson at the Margolis Center for Health Policy estimates, however, that such a set-up would only bring down overall insurance premiums in individual market by 2 percent, which he dubbed a “nothingburger.”
Under the proposal, the Department of Health and Human Services would have the final say until 2020 on which patients insurers would be reimbursed for and for how much. After that, states would make that determination.
This set-up is irksome to some Freedom Caucus members, including Rep. Louie Gohmert (R-TX), who told the Rules Committee on Thursday that the amendment attempts to solve the problem of too much federal power over health care by allowing even more federal power over health care. “Without other changes, I’m still a no,” he said.
Lawmakers leave D.C. on Friday for a two-week recess, during which they are likely to get an earful from constituents—both those upset they haven’t yet repealed the Affordable Care Act as they’ve promised for the past seven years, and those upset they are trying to kill President Obama’s health care reform.
Some members complained to TPM earlier this week that they are in a tough spot, returning to their districts having made few steps forward on health care. Collins said Thursday that this new amendment helps that particular dilemma.
“Everybody likes to see some progress,” he said. “I’ve always been very open with my district about where we’re at, but this gives me another talking point.”
Yet members of Congress who vowed to vote against the original bill, including Rep. Leonard Lance (R-NJ), say they are still not won over, and worry the high-risk pool program is a gateway to charging the sick and people with disabilities much more for health insurance.
“I believe it’s likely to threaten that, yes,” he told TPM. “I want to make sure no one is denied coverage due a pre-existing condition.”