PT: What's in the GOP's Latest Deal to Repeal Obamacare

What's in the GOP's Latest Deal to Repeal Obamacare
By Dan Diamond Politico April 26, 2017

It's here: Republicans' latest Obamacare repeal-and-replace proposal dropped last night, as top House conservatives and a prominent moderate try to jump-start the stalled American Health Care Act.

WHAT'S IN REPUBLICANS' LATEST DEAL — The eight-page amendment to the AHCA, which was hammered out by House Freedom Caucus Chairman Mark Meadows and Tuesday Group Co-Chair Tom MacArthur and scooped by POLITICO on Tuesday night, would allow states to opt out of Obamacare's regulations on essential health benefits, community rating requirements and how much older Americans are charged for coverage.

It also would permit states to reject the continuous coverage provision that Republicans have proposed in their replacement bill. See the legislative text.

House Republicans exempted themselves from the proposal, Vox's Sarah Kliff flagged first.

WHAT STATES WOULD NEED TO DO TO OPT OUT — Frankly, not that much. The amendment says that states would need to propose at least one of the following five to receive a waiver from HHS:

1) Reduce average premiums for coverage

2) Increase enrollment

3) Stabilize the market

4) Stabilize premiums for individuals with pre-existing conditions

5) Increase the choice of health plans

Based on the waiver, states also would have to set up a high-risk pool, presumably to push back on expected criticisms that the GOP plan would harm the sickest patients.

THE PRACTICAL IMPLICATIONS — The amendment dismantles major elements of the ACA that Republicans' previous proposal would've kept, which had been a sticking point for wary conservatives. But cutting those protections means that even more Americans stand to lose coverage, which was already a no-go for many moderates.

Notably, the Congressional Budget Office projected last month that Republicans' bill would result in 24 million fewer Americans having coverage in a decade. That number would likely increase under this amendment, a former CBO analyst told PULSE.

Expect quick reaction on the proposal: Both the Tuesday Group and the Freedom Caucus have meetings with their members today. But ahead of that ...

SOME HOLDOUT CONSERVATIVES ARE FLIPPING — Reps. Dave Brat and Scott DesJarlais, both of whom opposed prior versions of the bill, indicated they will support the legislation once the new provisions are added to allow states to opt out of some of Affordable Care Act consumer protections. More. Reps. Jim Jordan and Raul Labrador, fellow holdouts on the House Freedom Caucus, also indicated that they'd now support the bill, WaPo's Robert Costa reports.

Still, it's not clear if enough Freedom Caucus members will come on board to get Republicans the necessary votes, especially given that some moderates who previously supported the AHCA could now defect.

BUT TUESDAY GROUP MEMBERS ARE WARY OF MACARTHUR'S DEAL — The sophomore Republican has single-handedly kept the embers of the sputtering repeal-and-replace effort burning, huddling with the House's hard-line conservative Freedom Caucus to try and forge a deal and endearing himself to the White House.

But the MacArthur-as-Republican-health-care-savior narrative has irked some other GOP moderates, who say the New Jerseyan is flying solo in negotiations with the Freedom Caucus, POLITICO's Kyle Cheney, Rachael Bade and Katie Jennings report. Though he's one of three co-chairs of the Tuesday Group — a 50-member bloc of House Republican moderates — MacArthur has negotiated without the group's blessing in his quest to keep the health care talks alive, other Tuesday Group members say. More.

AND INDUSTRY EXPERTS WORRY IT WOULD MAKE THE MARKETS WORSE — Experts say that the amendment would eviscerate the health law's consumer protections by giving states too much flexibility to opt out of them.

"Frankly, 'lower premiums' is a ridiculous standard," health economist Craig Garthwaite told PULSE. "Evaluating a waiver based on a lower premium without any consideration of coverage or quality is just not a serious proposal."

"We should be looking for solutions that lower the cost of insurance by decreasing spending on care — not simply making plans less generous," Garthwaite added. "This reads like another example of a policy written by people who either don't know or don't care about how health markets work."