Republicans have a new plan to revive their overhaul of the healthcare system, and it may bring the party closer to passing their bill.
The amendment to the American Health Care Act, offered by Rep. Tom MacArthur of New Jersey, appears to satisfy many demands made by conservatives in the House GOP conference that originally sank the bill. However, questions remain over the ability to get moderates on board.
The new plan is broadly similar to the rough outline leaked on Thursday. It allows states to opt out of two of the biggest provisions of Obamacare, given that they have other measures in place, unless denied by the federal government.
Here’s a quick rundown of the key provisions of the amendment:
- Allows states to waive essential health benefits: Under Obamacare, health insurance plans were required to cover a baseline of health benefits such as maternity care and emergency room visits. Under the new amendment, states could define their own essential health benefits if they show that it would cause prices to decrease. This could allow states to eliminate some of the baseline benefits in the AHCA since covering fewer benefits would allow insurers to offer cheaper plans, but it could also end up with slimmer plans and less care for people enrolled.
- Allows states to waive aspects of the community rating: Under Obamacare, community rating rules made it so that insurers had to charge the same price to consumers in a certain area regardless of gender, pre-existing condition, and other factors. Under the AHCA’s new amendment, states could get around this rule if they provided some funding for people with pre-existing conditions to get coverage, participate in the “invisible high risk pools” established by the AHCA, or “provide incentives to appropriate entities” to “stabilise premiums.” While the bill says the waiver cannot limit access to people with pre-existing conditions, it is unclear what the baseline of funding would be to grant this waiver. Therefore, people with pre-existing conditions could still end up having higher costs.
- Default approval: States requesting a waiver would have to be denied within 60 days of notifying the Department of Health and Human Services. If the HHS does not explicitly deny the waiver request, it is approved. This would allow the Trump administration to decide how rigorous the process would be for states.
Still not a slam dunk
These new provisions have been key sticking points to bringing conservative members who originally prevented the plan from making it to a vote on board with the bill.
After the text of the bill was released on Tuesday, a number of conservatives came out in favour of the amended AHCA.
“It’s pretty much everything I was looking for in terms of concessions,” Rep. Scott DesJarlais, a member of the conservative House Freedom Caucus, told Bloomberg.
A number of other Freedom Caucus members came out in support of the amended bill and chair Rep. Mark Meadows told reporters after a meeting at the White House that he is “optimistic” about the plan.
Rep. Gary Palmer also told Axios “we’re really close, if not there” on getting enough votes to pass the bill.
However, questions remain as to if the AHCA has enough support from more moderate members of the party. Moderate GOP members were already concerned about concessions to conservatives regarding some of the essential health benefits and protections for pre-existing conditions.
Rep. Charlie Dent, a key moderate member of the House GOP, told the Washington Examiner that even with the MacArthur amendment he is against the AHCA.
“Based on what I’ve read, it does not change my position. I was a no, and I remain a no,” said Dent on Tuesday.