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Sunday, April 23, 2017

New GOP Health Care Plan is Better, But …

The new Republican health care plan is a big improvement over the disastrous proposed “American Health Care Act” (a.k.a RINOcare).

It doesn’t go far enough, of course.

And unfortunately, it doesn’t look like even this watered-down approach is enough to attract the squishy GOP moderates.

The new bill (actually an amendment to RINOcare) would retain many of Obamacare’s mandates such as guaranteed issue (the ban on insurers denying coverage), the 10 “essential” benefits, and the restrictions on premiums known as community rating.

However, state governments can apply for a limited waiver for the 10 essential benefits and much of the community rating. Insurers in states that gained a waiver would be able to underwrite premiums based on an applicant’s health status if the state establishes a high-risk pool or participates in a federal high-risk pool for those with pre-existing conditions. (For a definition of a high-risk pool, go here.)

At this point it’s not clear what the new GOP health care plan will do with Obamacare’s Medicaid expansion. Nor do we have information on whether people who use RINOcare’s tax credit will be able to save the difference between the tax credit amount and the cost of a health plan. I’ll have to see that before I’m willing to give this plan my stamp of approval. (Whatever that’s worth. – The Wife.)

That said, health insurance markets would work in states that gained a limited waiver. Markets would not descend into a death spiral as they currently are doing under Obamacareor would do in the original RINOCare. Indeed, the increased competition that happens as insurers re-enter the market would drive premiums down while improving the quality of coverage.

Unfortunately, this plan still leaves too much power in Washington, D.C.

Health insurance companies still can’t underwrite on the basis of sex and will still have restrictions on how far they can underwrite on the basis of age, although this is much better than what Obamacare permits. It also requires insurers to let pot-smoking, Cheeto-munching slackers stay on Mommy and Daddy’s insurance policy until age 26. Nor does it repeal the bans on annual or lifetime limits. Those are things that conservatives will have to come back for at a later date if this bill goes through.

Finally, if the bill fails this time it won’t be due to the House Freedom Caucus.  Rather, it will be those Republicans who are in need of a spine-insertion operation:

Insiders say the deal could probably deliver between 15 to 20 conservative House Freedom Caucus members who were previously “no” votes, so long as the text says exactly what was agreed to. But moderates — and more than a few traditional Republicans — say the deal is bad policy….

“The amendment doesn’t address the things that I had concerns about — the things I think are detrimental to the people I represent,” said Rep. Dan Donovan, a centrist New York Republican who is currently a “no” on the bill.

To be fair, some of this may be due to bad leadership, as was the case with Speaker Paul Ryan (R-Wisc.) and RINOcare:

Indeed, several centrist sources were incensed that Tuesday Group co-chair Tom MacArthur, the top negotiator for the moderates, agreed to the changes without getting the backing of his group. They’re not sure he can deliver the votes.

Still, there are changes Republicans can make to the federal high-risk pool that would likely get a lot of moderates on board.

I’ll go into that in my next post.

Crossposted at Bombthrowers.

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