NYAPRS Note: Please see, within our next posting, an alert to urge GOP House Representatives to reject an emerging second attempt to repeal the ACA.
Trump is Trying to Bring Obamacare Repeal Back From the Dead
By Abigail Tracy Vanity Fair April 4, 2017
Less than one month after Donald Trump abandoned the G.O.P.’s failed push to repeal Obamacare and Speaker Paul Ryan surrendered to the status quo as “the law of land,” White House officials are reportedly back at the negotiating table—this time aligning themselves with members of the far-right House Freedom Caucus that torpedoed their last health-care bill.
The effort to revive the zombie legislation centers on the idea that there is still a path to a compromise between conservative hardliners, who are agitating for a full repeal of Obamacare, and moderate Republicans, who hope to preserve some of the more popular provisions of the law.
On Monday, Vice President Mike Pence, Chief of Staff Reince Priebus, and budget director Mick Mulvaney reportedly met with representatives from both camps—the Freedom Caucus and the Tuesday Group, a 50-member caucus of moderate Republicans—to find some middle ground between the two, The Washington Post reports. “If conservatives want 100 percent repeal, let’s say moderates want 80 percent repeal,” Senator Rand Paul told reporters Monday, a day after playing a round of golf with Trump. “Let’s vote on 90 percent repeal, and be done with it.”
The proposals being put forward by the White House, however, look less like a compromise than a concession to the hardliners, including Paul, who derailed the original G.O.P. plan. They include allowing states the option to opt-out of a number of insurance regulations under Obamacare, including the “essential benefits” provision of the law, which mandates that all health-care plans cover things like in-patient and out-patient hospitalization, maternal care and childbirth, prescription drugs, and emergency services.
And while the proposal would technically keep the provision that bars insurance companies from denying coverage to individuals with pre-existing conditions, it would allow states to scrap the “community rating” provision, which would allow providers to charge higher rates to sick people, Axios reports. The plan would help cover those higher prices by allocating $115 billion through the Patient and State stability fund to assist sick people facing the highest costs. But the overall effect would be to make insurance cheaper for healthy people, particularly men, by making coverage much more expensive for everyone else.
Mark Meadows, the chairman of the Freedom Caucus, told reporters that the White House officials presented a “solid idea” on health care that could lead to compromise, and that his camp is “encouraged by the progress that we seem to be making.” Representative Scott DesJarlais echoed the sentiment. “It’s progress, and it’s promising,” the Tennessee congressman said. “We’re anxious to see the legislative text.”
Moderates in the House also appeared optimistic after the meeting but were still unsure whether the G.O.P. could reach a consensus on overhauling the $3 trillion health-care industry. “Anything’s possible,” Representative Tom MacArthur, a co-chairman of the Tuesday Group, said. “I’m not saying I think it’ll happen—I don’t know—but I think it’s possible.” The Post reports that Representative Chris Collins, another member of the Tuesday Group, was not sold on getting rid of the “community ratings” provision, though he suggested that he would be open to states deciding the issue for themselves, especially since New York already mandates it. “For those of us in my state, it’s no change at all,” he said.
Even if the bill survives a House vote—which White House officials have said could happen as early as this week—the Trump administration is sure to face an uphill battle in the Senate, where Republicans have a slim 52 to 48 margin. Moderates are likely to raise the same issues they had with the American Health Care Act, which would have made deep cuts to Medicaid and slashed the Obamacare subsidies that millions of Americans have come to rely on to afford insurance coverage.
If the new legislation strips away even more benefits, it may be dead on arrival. But allowing states additional flexibility to decide those issues for themselves could be a winning strategy to unite moderate Republicans with their more conservative colleagues. A spokesperson for Senator Mike Lee of Utah—who criticized the A.H.C.A. for not going far enough in dismantling Obamacare—wrote in an e-mail to the Hive, “We're not commenting on any offer until we see it in writing.”