Under pressure to deliver a win for President Trump, House Republicans are working on a new Obamacare repeal compromise that could bridge the divide between hard-line conservatives and centrists who tanked the first attempt.
The proposal by Rep. Thomas MacArthur, New Jersey Republican, would shift to the states the burden of deciding what services insurers must cover and would let insurers charge healthy customers less, so long as states set up risk pools to subsidize sicker people priced out of the market.
No state could waive the part of the Affordable Care Act requiring insurers to cover people with pre-existing medical conditions, however, preserving the most popular part of the 2010 Affordable Care Act.
“This amendment will make coverage of pre-existing conditions sacrosanct for all Americans and ensures essential health benefits remains the federal standard,” Mr. MacArthur, chairman of the moderate Tuesday Group, said on his Facebook page Thursday after Politico published a one-page description of his plan.
It’s unclear whether the proposal can win over enough holdouts to pass. Republicans’ first go-around last month ended in a mess after leaders were unable to muster the votes and had to yank the bill.
A Republican aide said lawmakers don’t even have legislative text of the proposal so they don’t know whether it can bridge the gap.
Yet President Trump was bullish about their progress, saying House Republicans could revive their plan and hold a vote either next week or shortly thereafter.
“The plan gets better and better and better, and it’s gotten really good,” Mr. Trump said at a joint press conference with Italian Prime Minister Paolo Gentiloni.
House Republicans are under immense pressure from the White House to deliver an Obamacare repeal, a campaign vow that hasn’t been fulfilled as Mr. Trump nears 100 days on the job.
Failing a second time would be a gut punch for the party as it tries prove it can wield all the levers of political power successfully. After health care, Mr. Trump wants to tackle tax reform and a $1 trillion infrastructure plan.
House Speaker Paul D. Ryan, Wisconsin Republican, signaled on Wednesday that negotiators were putting the finishing touches on a plan to bridge rifts within the party over health care, although lawmakers also must focus on a stopgap spending bill to keep the government funded when it returns from its two-week break.
“I want to get both,” Mr. Trump said. “I think we’ll get both.”
Under the MacArthur plan, states could ask Health and Human Services Secretary Thomas Price to waive Obamacare’s “essential health benefits” package, which requires insurers to cover a slate of services such as mental health and maternity care.
They also could scrap community rating, in which insurers are required to charge the same prices to everyone in a given area. Insurers wouldn’t be allowed to discriminate based on gender or age, though older people still could be charged up to five times more than young people.
States could allow insurers to charge sicker consumers more than healthy ones, so long as they set up a “high risk pool” to absorb some of their costs.
That could win over hard-line House Freedom Caucus members, though it may scare off centrists who don’t want to tweak the guarantees of Obamacare.
While sicker customers could still get covered, they might face high premiums, health care analysts said.
The analysts said legislative details will be crucial, including who would be in the high-risk pool and how much they would have to pay to get covered.
“Maybe this is enough to convince the Freedom Caucus people that states can do what they want to do, but I don’t see this as being very popular,” said Timothy Jost, a law professor at Washington and Lee University in Virginia who closely tracks the debate. “It would make coverage unaffordable for many older consumers and would segregate high-cost consumers in coverage that would likely be inadequate unless the high-risk pools were very generously funded.”
Democrats accused Republicans of making a bad bill worse.
“To make the bill more palatable to right-wingers, the big change appears to be the abandonment of the protections for people with pre-existing conditions. Yet another Trump promise shattered,” said Sen. Christopher Murphy, Connecticut Democrat. “The Republican health care repeal bill was an unworkable, unpopular piece of garbage a month ago, and it still is today.”
The published plan doesn’t provide much detail on the state waiver process, though it suggests waivers would be easy to obtain.
The HHS secretary is supposed to approve the plan within 90 days of determining it is complete, although states “must attest that the purpose of their requested waiver is 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.”
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