Republicans continue to operate on healthcare reform, but can they bring their bill back to life?
While President Donald Trump insists healthcare reform is still possible, House Republicans have yet to reach an agreement on a bill to repeal and replace the Affordable Care Act (ACA) after two failed attempts to bring the bill to a floor vote. And it appears a third try has now failed after the GOP fell short of the necessary votes.
On Tuesday, Rep. Mark Meadows (R-NC), head of the Freedom Caucus, which led the opposition to the first GOP reform package, told Reuters that Republicans lacked the necessary votes. He described the party as being “a handful of votes away” from the number needed to push the bill through the House of Representatives.
To make matters worse, Rep. Fred Upton (R-MI) stated on Tuesday that he will vote against the upcoming bill, said Dylan Scott of Vox. His reason for not supporting the bill shows that little progress has been made in finding a middle ground between moderate Republicans and the Freedom Caucus.
“I sat down with a number of Freedom Caucus folks yesterday and they’re not willing to budge,” Upton said. “We’ve talked about the protection for those with pre-existing illness for [the] last number of years. We’re not going to budge either.”
Nevertheless, GOP leaders continue to negotiate in hopes of structuring a healthcare reform plan amenable to both sides of the GOP. The president had previously voiced his desire to bring a healthcare bill to a vote, possibly sometime this week, and CNN reported Vice President Mike Pence intends to meet with Congressional Republican legislators on Tuesday to rally support. What form that bill will take, however, has yet to be determined as talks are still underway.
Passage of a GOP-sponsored healthcare reform law hinges primarily on the thorny question of how to insure individuals with pre-existing conditions. President Trump has strongly voiced his support for guaranteed coverage for people with pre-existing conditions — a key mandate under the ACA. “I want it [the bill] to be good for sick people,” Trump told Bloomberg News. “It’s not in the final form right now. It will be every bit as good on pre-existing conditions as Obamacare.”
The public also supports the mandated coverage for people with pre-existing conditions. A Washington Post poll showed 70% of respondents favored a law prohibiting insurance carriers from denying coverage to those with sustained health issues.
The problem lies with how to insure people who need expensive treatments for chronic medical conditions without increasing premiums for everyone in an aggregated risk pool. As Amber Phillips of the Washington Post explains, premiums rose under Obamacare because insurers cover medical costs for both sick and healthy people, which meant higher premiums for all.
Freedom Caucus members contend they have a solution to bring down premiums. Under the group’s proposal, states would establish high-risk pools where individuals with pre-existing conditions could purchase policies. Separating people with chronic health issues from the healthy would reduce premiums for those requiring minimal care, Freedom Caucus members say.
The group also proposes letting states set the essential healthcare benefits insurers must offer within their borders. Caucus members believe giving states this power will lower overall premium costs. However, these proposals have run into opposition from moderate Republican House members who fear high-risk pools will make it too difficult for the chronically ill and elderly to find affordable coverage.
One component of the original GOP-sponsored American Health Care Act (AHCA) dealt with Medicaid expansion — or rather the lack thereof. Under the AHCA, the federal government would have continued Medicaid reimbursements to the states until 2020. Conservative Freedom Caucus members objected to that extension, arguing the expansion should be repealed immediately.
Similar to the pre-existing conditions mandate, the public mostly supports Medicaid expansion, even in those states that declined it under the ACA. The University of Maryland’s Program for Public Consultation surveyed 7,000 registered voters from November 11, 2016 to January 18th. According to the study, 62% of people in eight states that opted against Medicaid expansion wanted to see their states take part in the expansion. Nationally, 64% said they were in favor of having states participate in expansion.
What to Tell Your Clients
As of now, healthcare reform remains fluid with no definitive resolution in view. Even if the GOP passes legislation in the House, the measure likely will be revised when it reaches the Senate floor. All you can do at this time is to stay up to date on any possible changes so you can answer your clients’ questions.
One concern that has been resolved — at least temporarily — was the possibility of ending the controversial federal subsidy to insurance companies for covering low-income individuals. President Trump had suggested ending those payments in an effort to force Democrats to negotiate on healthcare reform. But as the president and lawmakers scrambled late last month to pass a bill to avert a government shutdown, the White House reconsidered and agreed to fund those payments.
For now, any client who qualifies for ACA premium subsidies will continue to receive subsidies; however, this could be short-lived as the Trump administration and Democrats’ battle over the budget continues to wage on.