Just When ObamaCare Repeal Looked Doable…
The House Freedom Caucus is working overtime to craft fixes and compromises, but moderates now stand in the way.
Just weeks after President Donald Trump’s ObamaCare replacement plan fell short of the votes needed for passage, factions of the Republican leadership that were at loggerheads are now poised to give it new life as the 100th day of Trump’s administration nears. Or not. House leaders determined Thursday night that they’re still short of the votes needed, so they pulled the proposal for later. But all isn’t lost.
The key component to the revival of the American Health Care Act (AHCA) is an amendment brokered by Freedom Caucus Chairman Mark Meadows (R-NC) and Rep. Tom MacArthur (R-NJ) of the moderate House Tuesday Group. The compromise allows for states to opt out of key rules in ObamaCare.
In a formal statement, the Freedom Caucus stated, “While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower healthcare costs,” and “our work will continue until we fully repeal Obamacare.”
That the Freedom Caucus has endorsed a health care bill that doesn’t completely repeal ObamaCare may be disconcerting for some conservatives who want an all-or-nothing solution. Yet the compromise addresses some of the more serious concerns with ObamaCare as well as with the replacement originally put forth by the Trump administration.
Moreover, it allows conservative representatives to go back to their districts and defend a piece of legislation that falls in line with their promises to replace ObamaCare and to provide a system of health care that isn’t run out of Washington, DC.
Not everyone in the Republican leadership is ready to accept the new proposition. National Review writes, “It remains unclear, though, how moderates will come down on this new amendment. Though the Tuesday Group co-chair was essential in crafting this compromise, some moderate members of the House have expressed concerns that limited waivers allow states to take steps that will lead to a greater number of uninsured people or cause those insured under Obamacare to lose coverage.”
In fact, it’s the moderate opposition that’s holding things up now. And the Washington Examiner’s Byron York illustrates the problem with a simple question and answer: “Why can’t House repeal Obamacare? Because a lot of Republicans don’t want to.”
Clearly, some moderate Republicans are unwilling to repeal aspects of ObamaCare that may be politically popular in their home districts, and they think the Freedom Caucus compromise gives too much authority to the states. Yet the waivers don’t give individual states sweeping authority to simply back out of any provision they oppose.
According to a draft of the proposal, in order for states to have their waivers approved, they may have to show proof that the waiver is designed to “reduce premium costs, increase the number of persons with health care coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions.”
In fact, the states will have limited flexibility even if the revised version of the AHCA becomes law. For example, in order for states to eliminate the types of services that insurance companies must offer or to prevent insurers from charging more for the health condition of patients, they will have to take part in high-risk pools.
Additionally, one of the remaining obstacles is that moderate Republicans want patients with preexisting conditions to be covered by the new system as they are in ObamaCare. And this may be one of the pieces that conservatives will have to live with due to popular expectations having changed.
Making matters more complicated is that a significant number of Americans prefer minimum insurance coverage and fear that a more conservative health care system will result in cuts to Medicaid. So even if a compromise is reached in the House, its viability in the Senate is in question.
There’s no doubt that Trump’s pressure on Congress to make something happen is closely tied to the widespread media coverage his presidency will receive on its 100th day. At the same time, Trump realizes that his supporters simply expect something to get done. Thus far, public opinion polls show that most of Trump’s ardent backers are dismayed over the failure of the administration to get an acceptable bill into law the first time around. But they’re not holding Trump completely accountable because of the short window he’s had to turn around a massive and complex program such as ObamaCare.
What conservatives should take away from the latest developments regarding health care is that the new AHCA amendment takes us closer than ever before to at least a partial repeal of ObamaCare — if all factions of the GOP can come together. And regardless of what inspired the latest round of negotiations, a revised version of the AHCA would be a victory for conservatives and the nation.
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