Diary

Stop the presses ... the outline of a healthcare deal is now visible

The Freedom Caucus/Conservative Senators appear to have voiced what an acceptable change to the AHCA bill would look like.  The key concession is more explicit language on the repeal of the “required benefits” under the ACA.  Such language is absent from the 2015 “full repeal” of the ACA that President Obama vetoed, but apparently the inclusion of this additional provision appears to carry the day for conservative opponents of the AHCA.

The Wall Street Journal reports tonight that:

To win over conservatives, GOP leaders Wednesday night were exploring whether they could remove the ACA’s requirement that many insurance policies cover 10 specific benefit categories, known as essential health benefits, that include maternity care and certain pediatric and mental-health services. Conservatives believe the requirement has made premiums more expensive.

Until Wednesday night, House GOP leaders had warned conservatives that eliminating the coverage requirements in the House bill would risk stripping it of its special procedural status when it goes to the Senate. Republicans are using a procedural shortcut tied to the budget that would enable them to pass the health bill with just a simple majority in both chambers.

But Wednesday evening, House GOP leaders said they got new advice from Senate Republicans: While the change might not survive in the Senate, it wouldn’t enable Democrats to block the whole bill, a GOP leadership aide said. It wasn’t yet clear whether a deal could be reached among GOP leaders, conservative lawmakers and the White House, but such an agreement could grant conservatives their biggest request to roll back more of the ACA’s regulations in the bill coming to the House floor Thursday.

“We’re encouraged tonight at the real willingness of not only the White House, but our leadership, to make this bill better,” House Freedom Caucus Chairman Mark Meadows (R., N.C.) said Wednesday night. He said a deal hadn’t yet been reached, but noted that Mr. Trump called Mr. Meadows to urge the process along.

“We’re very optimistic that if we work around the clock between now and noon tomorrow that we’re going to be able to hopefully find some common ground,” Mr. Meadows said.

Of course, any change welcome by some will be disliked by others.  Market forces make health insurance more expensive for the sick and elderly, for example.

If the benefits are repealed, costs are likely to rise for sicker and older people who are more likely to want generous policies that cover more. Younger, healthier consumers then are more likely to purchase skimpier health plans.

Democrats are already threatening a showdown on whether the change will survive reconcialiation.

Senate Democrats said Wednesday night that Republicans wouldn’t be able to retain the provision eliminating those benefits if the bill makes it over to the Senate.

“It will require 60 votes to repeal these protections, and the votes just aren’t there in the Senate,” said Matt House, spokesman for Senate Minority Leader Chuck Schumer (D., N.Y.) “It speaks volumes about the Republican Party that they need to try to make this bill worse for the American people in order to buy off the Freedom Caucus and other conservatives.”

It looks the reconciliation process is going to come to a head in the Senate.  It appears that the conservative Senators who have promised a reconciliation process that is broader in scope than the narrow interpretation feared by Paul Ryan will get their chance to be proven right or wrong.

Additional information on the discussion between the various factions can be found in this story by the Washington Post.