Oba­macare re­peal, Take 2, gains steam

Trump presses House GOP for win this time

The Washington Times Daily - - FRONT PAGE - BY TOM HOW­ELL JR.

Un­der pres­sure to de­liver a win for Pres­i­dent Trump, House Repub­li­cans are work­ing on a new Oba­macare re­peal com­pro­mise that could bridge the di­vide be­tween hard-line con­ser­va­tives and cen­trists who tanked the first at­tempt.

The pro­posal by Rep. Thomas MacArthur, New Jersey Repub­li­can, would shift to the states the bur­den of de­cid­ing what ser­vices in­sur­ers must cover and would let in­sur­ers charge healthy cus­tomers less, so long as states set up risk pools to sub­si­dize sicker peo­ple priced out of the mar­ket.

No state could waive the part of the Af­ford­able Care Act re­quir­ing in­sur­ers to cover peo­ple with pre-ex­ist­ing med­i­cal con­di­tions, how­ever, pre­serv­ing the most pop­u­lar part of the 2010 Af­ford­able Care Act.

“This amend­ment will make cov­er­age of pre­ex­ist­ing con­di­tions sacro­sanct for all Amer­i­cans and en­sures essen­tial health ben­e­fits re­mains the fed­eral stan­dard,” Mr. MacArthur, chair­man of the mod­er­ate Tues­day Group, said on his Face­book page Thurs­day af­ter Politico pub­lished a one-page de­scrip­tion of his plan.

It’s un­clear whether the pro­posal can win over enough hold­outs to pass. Repub­li­cans’ first go-around last month ended in a mess af­ter lead­ers were un­able to muster the votes and had to yank the bill.

A Repub­li­can aide said law­mak­ers don’t even have leg­isla­tive text of the pro­posal so they don’t know whether it can bridge the gap.

Yet Pres­i­dent Trump was bullish about their progress, say­ing House Repub­li­cans could re­vive their plan and hold a vote ei­ther next week or shortly there­after.

“The plan gets bet­ter and bet­ter and bet­ter, and it’s got­ten re­ally good,” Mr. Trump said at a joint press con­fer­ence with Ital­ian Prime Min­is­ter Paolo Gen­tiloni.

House Repub­li­cans are un­der im­mense pres­sure from the White House to de­liver an Oba­macare re­peal, a campaign vow that hasn’t been ful­filled as Mr. Trump nears 100 days on the job.

Fail­ing a sec­ond time would be a gut punch for the party as it tries prove it can wield all the levers of po­lit­i­cal power suc­cess­fully. Af­ter health care, Mr. Trump wants to tackle tax re­form and a $1 tril­lion in­fra­struc­ture plan.

House Speaker Paul D. Ryan, Wis­con­sin Repub­li­can, sig­naled on Wed­nes­day that ne­go­tia­tors were putting the fin­ish­ing touches on a plan to bridge rifts within the party over health care, although law­mak­ers also must fo­cus on a stop­gap spend­ing bill to keep the govern­ment funded when it re­turns from its two-week break.

“I want to get both,” Mr. Trump said. “I think we’ll get both.”

Un­der the MacArthur plan, states could ask Health and Hu­man Ser­vices Sec­re­tary Thomas Price to waive Oba­macare’s “essen­tial health ben­e­fits” pack­age, which re­quires in­sur­ers to cover a slate of ser­vices such as men­tal health and ma­ter­nity care.

They also could scrap com­mu­nity rat­ing, in which in­sur­ers are re­quired to charge the same prices to ev­ery­one in a given area. In­sur­ers wouldn’t be al­lowed to dis­crim­i­nate based on gen­der or age, though older peo­ple still could be charged up to five times more than young peo­ple.

States could al­low in­sur­ers to charge sicker con­sumers more than healthy ones, so long as they set up a “high risk pool” to ab­sorb some of their costs.

That could win over hard-line House Free­dom Cau­cus mem­bers, though it may scare off cen­trists who don’t want to tweak the guar­an­tees of Oba­macare.

While sicker cus­tomers could still get cov­ered, they might face high pre­mi­ums, health care an­a­lysts said.

The an­a­lysts said leg­isla­tive de­tails will be cru­cial, in­clud­ing who would be in the high-risk pool and how much they would have to pay to get cov­ered.

“Maybe this is enough to con­vince the Free­dom Cau­cus peo­ple that states can do what they want to do, but I don’t see this as be­ing very pop­u­lar,” said Ti­mothy Jost, a law pro­fes­sor at Wash­ing­ton and Lee Univer­sity in Vir­ginia who closely tracks the de­bate. “It would make cov­er­age un­af­ford­able for many older con­sumers and would seg­re­gate high-cost con­sumers in cov­er­age that would likely be in­ad­e­quate un­less the high-risk pools were very gen­er­ously funded.”

Democrats ac­cused Repub­li­cans of mak­ing a bad bill worse.

“To make the bill more palat­able to right-wingers, the big change ap­pears to be the aban­don­ment of the pro­tec­tions for peo­ple with pre-ex­ist­ing con­di­tions. Yet an­other Trump prom­ise shat­tered,” said Sen. Christo­pher Mur­phy, Con­necti­cut Demo­crat. “The Repub­li­can health care re­peal bill was an un­work­able, un­pop­u­lar piece of garbage a month ago, and it still is to­day.”

The pub­lished plan doesn’t pro­vide much de­tail on the state waiver process, though it sug­gests waivers would be easy to ob­tain.

The HHS sec­re­tary is sup­posed to ap­prove the plan within 90 days of de­ter­min­ing it is com­plete, although states “must at­test that the pur­pose of their re­quested waiver is to re­duce pre­mium costs, in­crease the num­ber of per­sons with health care cov­er­age or ad­vance an­other ben­e­fit to the pub­lic in­ter­est in the state, in­clud­ing the guar­an­tee of cov­er­age for per­sons with pre-ex­ist­ing med­i­cal con­di­tions.”

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