The American Health Care Act, which was dead, may now be undead, or at least that is the hope of White House officials negotiating with conservative members of the House Freedom Caucus to revive the bill, Politico reported.
The apparent terms of the bill's revival do not make a great deal of political sense.
Matt Fuller, who covers the Freedom Caucus for The Huffington Post, reports that the head of the Freedom Caucus, Rep. Mark Meadows, said he believed that the deal would allow states to waive the essential-health-benefits rules under Obamacare — those are the rules that say health plans have to cover certain benefits like maternity care, prescription drugs, and hospitalization — and, in a change from the previous version of the AHCA, would allow them to waive a rule called community rating.
Community rating is the rule that says insurers have to charge customers the same price, except that they may impose limited surcharges based on your age and whether you smoke. An insurer is not allowed to charge you more just because you are sick.
The Freedom Caucus wants to give insurers much more freedom to charge different customers different prices, and it has some not-crazy reasons. In particular, as I wrote a couple of weeks ago, if you eliminate the essential-health-benefits rules and keep other Obamacare regulations, it might become impossible to sell certain kinds of insurance coverage to anyone.
People who want coverage for expensive benefits, such as substance-abuse treatment, might wait until they need the coverage to buy it. Insurers, unable to block specific customers, would have to price insurance on the assumption that any buyer is buying a specific benefit because he or she intends to use it. Ultimately, the pricing for many benefits would become so unattractive that insurers would stop selling coverage for them altogether.
Obamacare prevents this problem by making everyone buy approximately the same basket of coverage. Under the amorphous new deal being discussed, this problem would be addressed through insurers' new freedom to price products however they wish for different customers.
Insurers still couldn't tell a person with cancer that he or she can't get chemotherapy coverage, but they could tell the person that coverage would cost $10 million a year, which is kind of like saying the person can't have the coverage at all. This pricing flexibility would keep the sickest patients out of the insurance pool and thereby make it economical to sell coverage for chemotherapy at a reasonable price to customers who do not have cancer.
You can see the political problem, right?
It's part of a broader problem on healthcare for Republicans: While they got a lot of political buy-in for the idea that Obamacare "should be repealed and replaced," there was not buy-in from the electorate for Republicans' preferred terms for the replacement, such as that cost-shifting from the sick to the healthy should be greatly reduced.
Of course, a reduction in cost-shifting might even sound good at first pass. ("Why should I pay for somebody else's healthcare?") But when the specific effects become clear — the matter of greatly jacking up insurance rates for expectant mothers and cancer patients so young, healthy men can pay less — the politics become toxic.
If and when a revised AHCA becomes available containing this provision, it will most likely hit the same political wall that the previous AHCA did: The proposal will be very unpopular, with a loud and angry constituency opposing it, and no significant political constituency eager for it, except for rich people who want the tax cut embedded within the AHCA.