It appears that House Republicans are once again attempting to reanimate the corpse of their much-hated health care bill, this time in the hopes that they can give President Donald Trump some semblance of a legislative victory to brag about in time for his 100th day in office. Politico has posted an outline of the deal, which was negotiated by Rep. Tom MacArthur, a leader of the moderate Tuesday Group, and Freedom Caucus Chair Mark Meadows, who on his better days sort-of-kind-of speaks for Congress’s fringier conservatives.
The “Macarthur Amendment”—as this bargain is being called—doesn’t include many dramatic new ideas. Mostly, it appears to set down on paper a formula Republicans were reportedly discussing two weeks ago, which would give states the ability to opt of the Affordable Care Act’s key insurance-market regulations, including the essential benefit rules that require health plans to cover certain categories of medicine, such as hospitalization, mental health, and maternity care. In order to do so, states would be required to apply for a waiver from the federal government, promising that their changes were intended to “reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state”—which seems broad enough to be perfectly meaningless. I’m sure that’s the point.
The amendment’s major compromise appears to involve Obamacare’s community rating restrictions, which currently prevent insurers from charging customers more for coverage if they have pre-existing conditions. In order to waive those, states will have to first establish a high risk pool of subsidized insurance for the sick, for which Trumpcare would provide at least some funding. So, Mississippi and South Carolina would be required to offer at least a minimal insurance safety net for people with health problems before effectively shutting them out of the normal individual market.
Which isn’t really much of a relief. At least in its current form as a bullet-point outline, the MacArthur amendment says nothing about how much money states will need to spend on their new high risk pools. In the past, these fall-back insurance options for the sick have been notorious for high premiums and long waitlists, mostly because legislatures haven’t been willing to pony up enough funding to make them work properly.
As I’ve written before, allowing states to opt out of Obamacare’s insurance regulations in order to bring down the cost of coverage is probably a more intellectually coherent policy approach than the bizarre mish-mash Paul Ryan & Co. initially dreamed up for the American Health Care Act. But it’s probably best to take the broad view here. Ultimately, House Republicans are talking about mere tweaks to a monstrous piece of legislation that would leave millions uninsured. It still guts Medicaid. It’s still designed to bring down the cost of insurance for young and healthy Americans by forcing the old and sick to pay more. Depending on how they eventually structure Trumpcare’s insurance subsidies, some states could find their individual insurance markets transformed into hotbeds for scams.
And, it might be dead of arrival in the Senate, anyway. Aside from the fact that some Republican moderates will probably feel squeamish about yanking health care from their constituents, many of the regulatory changes House members are demanding might not be permissible under the upper chamber’s reconciliation rules, which Republicans are relying on to avoid a filibuster. These on-again-off-again negotiations may be for naught.
In any event, the world’s world’s most agonizing zombie movie is still stumbling on.