Yes, Trumpcare is back.
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The widely hated Republican healthcare plan somehow isn't dead yet: Last night, Congressman Tom MacArthur of New Jersey finalized an amendment to the American Health Care Act, which people are now aptly calling Zombie Trumpcare or Vampire Trumpcare. What would the amendment do, exactly?
It would allow states to opt out of two very popular and important Obamacare requirements outlined below, but a spokesperson for Rep. MacArthur told Vox that members of Congress and their staff would get to keep these regulations in their own insurance, which they buy from the healthcare marketplace. The amendment writers loved the changes so much they exempted themselves from them. This section was basically hidden in the amendment, and once it got out some lawmakers denied its existence. Now MacArthur's office says it was added at the insistence of the Senate Budget Committee but he is working to remove it.
But back to the terrible MacArthur amendment, which was leaked to Politico. It says states can waive stipulations which say that insurers can't charge people more for having preexisting health conditions and that they must cover 10 essential health benefits, which include maternity care and mental health and addiction treatment. It would also let states choose to charge older people higher premiums. The nonpartisan Congressional Budget Office estimated that the original Trumpcare bill would result in 24 million more uninsured people; these actions would raise costs for lots of people and would undoubtedly result in even more people dropping out of their coverage or never buying it in the first place.
Here's exactly what it says. The amendment would allow states to waive what's known as the community rating provision. Before Obamacare, insurers would individually rate people looking to buy coverage directly from the insurer and offer them a price based on their expected health costs. If you had a lot of health problems, you could be charged more. Obamacare banned individual rating and required insurers to use community rating, or setting one premium for an entire community that wants insurance. This made insurance cheaper for sicker people but more expensive for healthier people. The amendment says insurers can only individually rate people who've had a lapse in insurance coverage and now want to buy a plan. And states can only opt out of community rating if they participate in the Patient and State Stability Fund, which in theory is a pile of money to help people afford their insurance but, as Vox points out, states aren't required to use it that way. So people with preexisting conditions could be shit out of luck.
States could also waive the essential health benefits (EHB) requirement, meaning insurers could sell plans that look cheaper but would ultimately result in higher costs for people who need anything more than bare bones coverage. Cutting access to mental health and addiction treatment right now is not a good look. Oh, and states that do away with EHBs would once again permit price discrimination against women simply because they're the only people who can bear children and thereby allow for the continued existence of the human race. One estimate found that insurers could charge women $17,000 more just for having delivered a child in the past with zero or only minor complications. (Is that robowomb ready yet?)
This afternoon, the staunchly conservative House Freedom Caucus endorsed it. A reminder: This is the group that wasn't on board with the previous iteration of the bill; the White House knew it wouldn't pass without those approximately three dozen votes, so they extended an olive branch by offering to repeal the essential health benefits requirements. But the Freedom Caucus didn't bite, so Speaker Paul Ryan pulled the bill from the House floor right before it was going to be voted on on March 24. It appears they like the much crueler amendment that waives both EHBs and preexisting condition protections.
MacArthur is a co-chair of the moderate Tuesday Group and he allegedly negotiated with Freedom Caucus chair Mark Meadows on the amendment. But MacArthur's counterpart Charlie Dent has said he doesn't like the proposed changes. So it's completely unclear what the future holds for Zombie Trumpcare: Will it even get a vote? If so, would it get the 216 votes needed to pass the House with the Freedom Caucus on board? Could it really pass the more moderate Senate? Stay tuned for the next episode of White Men Gambling With Your Life.
Update 4/28/17: House Speaker Paul Ryan and his lieutenants decided during a meeting late Thursday night to postpone a vote on the AHCA with the MacArthur amendment because they still didn't have enough support. Politico reports that Republicans can only afford 22 "no" votes to get the bill passed and as of Thursday there were at least 15 nos and 20 more that were leaning no or undecided.
Update 5/4/17: MacArthur's office said he would work to remove the portion of the bill that exempted members of Congress but that provision is still in the bill that's set to be voted on; the fix will be contained in separate legislation. HR 2192 would need 60 votes to pass the Senate unlike the AHCA, which is considered a budget reconciliation bill, and only needs 51 votes to pass.
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