Trumpcare Lives? GOP Plans Another Try To Kill Obamacare

WASHINGTON, DC — White House officials plan to bring a revive the American Health Care Act, the Republican alternative to Obamacare that had been presumed dead in March when it failed to get enough support to get through the House of Representatives. Party leaders hope to bring a revised version of the health plan to a House vote as early as Wednesday, according to Washington Post reporter Robert Costa.

Party leaders and the White House have been involved in negotiations to craft a bill that will include enough cuts in health care funding to get the support of conservative Republicans while ensuring that the cuts are not so deep that insurance premiums would increase for the middle class and elderly, which would cost the support of moderates in the party.

President Trump denied in a press conference Thursday that Republicans had backed off health care when the original version of their AHCA failed. "It was reported there was a give-up," Trump said. "There was never a give-up."

It was Trump himself, though, who delivered an ultimatum to House Republicans in March to repeal and replace Obamacare or live with it. When the bill stalled without a vote, Trump said he was moving on to "big tax cuts and tax reform. That will be next."

He may have decided to reverse himself by the realization that health care reform first could help passage of his tax legislation. In March, Republicans had counted on passing their health plan and shifting $1 trillion now used for health care to help pay for tax cuts. Even if they had secured that extra $1 trillion in March, passing tax reform would have been complicated because of Congressional rules and the GOP's narrow majority in the Senates.

Without that $1 trillion, things get even more difficult.

The changes to the health bill now being discussed will weaken protections for people with pre-existing conditions and may make the 2.0 version worse than the original in the eyes of many more moderate Republicans.

At the heart of the negotiations are two provisions of Obamacare that have been brought up before: essential health benefits and community ratings. Republicans are discussing a provision to leave it to states to decide whether to weaken those requirements.

The idea of rolling back these rules has come up before. As Patch explained previously:

In plain English, these rules mean that all insurers have to include a certain set of 10 health benefits, such as mental health care and maternity coverage, and all members of certain insurance pools have to pay the same rate, regardless of their current health status.
If you repeal "community ratings," sick people could get charged incredibly high amounts for their necessary coverage.
Josh Barro, writing for Business Insider, argues that repealing "essential health benefits" while keeping the community ratings would create perverse incentives for insurers.
"People who want coverage for expensive benefits, such as substance-abuse treatment, might wait until they need the coverage to buy it," wrote Barro.
He continued: "Insurers, unable to block specific customers, would have to price insurance on the assumption that any buyer is buying a specific benefit because he or she intends to use it. Ultimately, the pricing for many benefits would become so unattractive that insurers would stop selling coverage for them altogether."

Others argue that repealing these provisions would allow insurers and patients more freedom to operate in an unregulated market, thus keeping insurance prices down.

If the Republicans are to cut $1 trillion in current health care funding, millions of people who are now insured would likely lose their coverage. The Congressional Budget Office had predicted that 24 million people would lose coverage by 2024 had the original bill became law.

Moreover, while the bill putatively preserves the ban on denying people coverage for pre-existing conditions, which President Trump has repeatedly pledged to protect, insurance premiums for this group could skyrocket to unaffordable rates. There isn't much of a difference between telling someone they can't buy insurance and telling someone that they can only buy it for $100,000 a year.

At the same time, a new Quinnipiac poll says that only 36 percent of U.S. voters want Congress to try again to "repeal and replace" Obamacare. Sixty percent think Republicans should move on to something else. Previous versions of the AHCA only received support from 17 percent of survey respondents, and most major interest groups opposed the bill.

Voters disapprove, 65 29 percent, of the way Trump is handling health care and say by a 54-22 percent margin that he is handling health care worse than former President Barack Obama. Another 19 percent say he is handling it about the same as President Obama.

Still, Republicans ran on repealing and replacing Obamacare for seven years and were elected, in part, on that pledge. And there are real problems in the Obamacare marketplaces that need thoughtful solutions. It may be difficult for Republicans to feel they can just "move on" from what has long been their central priority.

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