A month after forcing House Speaker Paul Ryan (R-Wis.) to withdraw his ObamaCare replacement bill, the House Freedom Caucus has thrown its weight behind the legislation after it was amended to allay some members’ concerns.
“Over the past couple of months, House conservatives have worked tirelessly to improve the American Health Care Act (AHCA) to make it better for the American people,” the Freedom Caucus said in a statement issued Wednesday. “Due to improvements to the AHCA and the addition of Rep. Tom MacArthur’s proposed amendment, the House Freedom Caucus has taken an official position in support of the current proposal.”
MacArthur (R-N.J.), co-chairman of the Tuesday Group of moderate Republicans, negotiated the amendment’s language with Freedom Caucus chairman Mark Meadows (R-N.C.).
According to the New York Times:
The latest proposal … would allow states to obtain waivers from federal mandates that insurers cover certain “essential health benefits,” like emergency services, maternity care, and mental health and substance abuse services, which many Republicans argue have driven up premiums.
It would also permit states to get waivers allowing insurers to charge higher premiums based on a person’s “health status,” if a state had a program to help pay the largest claims or had a high-risk pool where sick people could purchase health insurance.
To qualify for a waiver, a state would have to explain how it would advance at least one of five purposes: reducing average premiums for consumers; increasing the number of people with coverage; stabilizing the insurance market; increasing the choice of health plans; or stabilizing premiums for people with pre-existing conditions.
In short, the amendment gives states some flexibility that may help reduce insurance premiums, but only if states do as Washington says.
Moreover, as USA Today pointed out, it “leaves many of the mandates from Obamacare in place,” including bans on charging men and women different rates and denying coverage to individuals with pre-existing conditions.
Even former AHCA opponents who have decided to support the amended bill admit it’s far from the complete repeal of the Affordable Care Act (ACA) that the GOP promised to deliver — and indeed did deliver, but only when it could be sure the man in the White House would veto it.
“The MacArthur amendment will grant states the ability to repeal cost driving aspects of Obamacare left in place under the original AHCA,” the Freedom Caucus said in its statement. “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.”
Heritage Action for America dropped its opposition to the bill with the adoption of the MacArthur amendment. “To be clear, this is not full repeal and it is not what Republicans campaigned on,” CEO Michael Needham said in a statement. “The amendment does, however, represent important progress in what has been a disastrous process.”
FreedomWorks, too, signed onto the AHCA, though it confessed that “the amendment represents a perverse form of ‘federalism’ that continues to perpetuate federal health insurance regulation.”
Not everyone, however, was won over by the amendment.
Representative Andy Biggs (R-Ariz.), a member of the Freedom Caucus, told USA Today, “As amended, the American Health Care Act (AHCA) would not be the clean repeal of Obamacare I promised and would not lower premiums to pre-ACA levels.” (Only 80 percent of caucus members have to vote to support a bill for the group to issue an official endorsement.)
“I was opposed to it before. I’m still opposed,” Representative Charlie Dent (R-Pa.), MacArthur’s Tuesday Group co-chairman, told reporters.
Dent accused the Freedom Caucus of staging “an exercise in blame-shifting.” Conservatives took the blame for the AHCA’s initial failure and, by endorsing it with an amendment they know most moderate-to-liberal Republicans won’t like, are hoping to make those congressmen the fall guys if the bill flops once again. MacArthur himself “acknowledged that the new amendment flipped the narrative from the Freedom Caucus being obstructionists to moderates being the ones who could hold up the bill,” noted USA Today.
Democrats, naturally, remain unalterably opposed to any significant alterations to ObamaCare, which means nearly all Republicans have to vote for the bill for it to pass the House. According to the Washington Post, “Republican leadership can afford to lose only about 20 votes if most of the Freedom Caucus backs the measure. As of Wednesday afternoon, roughly 30 Republicans who are not members of the Freedom Caucus were either opposed or undecided.”
Ryan indicated that the revised bill might be brought to a vote in the near future. “We’ll vote on it when we get the votes,” he said. The Times suggested that could occur “as early as Friday.”
If the bill passes the House, it will face even greater obstacles in the Senate, where Republicans hold a very slim majority. With some of them already expressing skepticism about the bill, particularly its (largely phantom) Medicaid cuts, the Times observed, “the more that the bill changes to get through the House, the less chance it has of surviving in the Senate.”
The one change that everyone wants to see, it seems, involves health insurance for members of Congress. Under the amended AHCA, states will be allowed — but not required — to waive ObamaCare’s “essential health benefits.” In addition, congressmen, senators, and their staff members must remain in the ObamaCare exchanges, as the 2010 healthcare law mandated. “The District is unlikely to seek a waiver to opt out of the ACA’s coverage requirements, meaning members’ plans would be left intact, even if insurers in their home states are allowed to cut benefits,” wrote the Post.
Democrats portrayed this as Republicans’ trying to exempt themselves from their own healthcare bill, although as Meadows explained, “it actually penalizes members of Congress” by forcing them to remain under ObamaCare rather than revert to the extremely generous federal health-insurance program. Nevertheless, he said, “We understand the optics, and we’re working on that to make sure that it gets fixed.”
Will the AHCA pass this time? Multiple news sources report that the Freedom Caucus endorsement, coupled with pressure from the White House to get some kind of ObamaCare modifier passed within President Donald Trump’s first 100 days, has given the bill “momentum.” But there are still many objections to overcome, not least of which is that even the amended AHCA is no more constitutional than the ACA. Mr. President and Speaker Ryan, which is more important: getting it done fast or getting it done right?