It seemed unlikely that U.S. House Republicans could propose something worse than the American Health Care Act, the Obamacare replacement that collapsed under its own unpopularity just weeks ago.
It seemed implausible that Republicans would craft a bill that took the parts of the AHCA that were awful for Americans – higher premiums and deductibles plus 24 million fewer people getting insurance coverage – and make something even harsher.
And yet, House Republicans did exactly that last week with a new Obamacare replacement that, so far, is suffering the fate of the last Obamacare replacement. Late in the week, House leaders abandoned plans to hold a health care vote, a sure sign they still don’t have enough votes to pass the measure.
But those who celebrated the AHCA’s demise should be careful not to dismiss too quickly the chances of version 2.0, because Republicans leaders have done two important things that might ultimately provide them a path toward passage.
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First, they’ve crafted a health care bill that finally appeals to House Freedom Caucus members, who helped scuttle the AHCA because it wasn’t sufficiently conservative. To woo those votes, the new health care bill lets insurers ask for waivers on Obamacare mandates requiring them to cover essential health benefits like hospital visits, prescription drugs and maternity care. Insurers also could get waivers that allow them charge people more for prexisting conditions.
None of that is good for the millions of Americans who will be left with less coverage and higher health care costs, but that’s not been much of a concern of conservative GOP lawmakers who just want Obamacare gone.
Could this Obamacare replacement pass the more moderate Senate, where Republicans have far fewer votes to spare? Probably not, but Republicans have given it the best chance possible with a second maneuver, one that’s a very old and very potent political trick: Passing the buck.
The decision to give insurers waivers on basic Obamacare benefits would lie with the states, not Congress. States could grant waivers if insurers satisfy just one of five broad policy goals, including the nebulous “Stabilizing the market for health insurance coverage in the State.” In North Carolina, for example, an insurer could claim to satisfy that goal simply by returning to a market where many consumers have just one choice of insurance company.
This is appealing to Republicans in Washington on a couple of levels. It makes health care coverage a state issue – always a plus for small-government conservatives and their supporters. But also, it provides possible cover to lawmakers who want credit for repealing Obamacare but not blame for the consequences.
For now, that’s not enough for moderate Republicans who worry that their constituents with preexisting conditions will know who abandoned them. The best way out of this, of course, is to improve Obamacare, which Americans like and want to keep. But politics, not the best possible health coverage, is sadly what this is all about.