The immediate politics of the latest iteration of the Republican healthcare bill make sense for some Republicans, particularly for members of the House Freedom Caucus who would like to not be blamed anymore for the bill’s demise.
But this new proposal is ugly for moderates, both substantively and politically, and they are likely to pay a political price if they support it.
There is nothing in this revision for those Republicans who opposed the American Health Care Act. It would throw too many people off health insurance, disrupt healthcare markets too much, and expose people to too much risk if they got sick. In fact, this bill would be worse on the dimensions those members worried about before.
The latest proposal would allow states to opt out of Obamacare rules that require health insurance to cover core benefits like prescription drugs and hospitalization, and out of rules that prohibit insurers from charging you more if you have a preexisting condition.
That is, under this plan, insurers could sell plans that don’t cover pregnancy or even doctor visits. It would ensure that everyone has “access to coverage” only in the sense that insurers would have to offer to sell a plan to anyone. They could set the premium at $10 million for people with preexisting conditions, and that offer of insurance at $10 million would constitute “access to coverage.”
Last month, many members on the moderate end of the Republican House conference made on-the-record statements about why they opposed the AHCA that would seem to box them into opposing this version, too.
Rep. Ileana Ros-Lehtinen of Florida said that if the AHCA were passed, “too many of my constituents will lose insurance and there will be less funds to help the poor and elderly with their healthcare.” This amendment does nothing to address those concerns.
Rep. Rodney Frelinghuysen of New Jersey objected because of the bill’s “denial of essential health benefits in the individual market,” as well as its cuts to Medicaid. Those issues remain substantially the same in the new bill.
Rep. Barbara Comstock of Virginia said she opposed the bill because of “uncertainties” it would create, but she said at least it required insurance to cover preexisting conditions – a proviso that would no longer hold with the new version.
And Rep. David Young of Iowa said he didn’t “think people should be discriminated on” because of preexisting conditions. This bill would allow insurers to do so.
If they voted for this new version, these members and many others would be subject to attacks based on their past statements – they said the healthcare bill was unacceptable, and then they voted for it after it was made even more unacceptable.
That’s not to say they can’t change their minds. But I wouldn’t assume they will.
Many of these “moderate” defections were unexpected the first time around and came from members who aren’t even that moderate – including Frelinghuysen, who chairs the House Appropriations Committee and is close to leadership.
Frelinghuysen represents an affluent, highly educated suburban district, centered on Morris County, New Jersey, which has been Republican for approximately forever but has trended Democratic in recent years. His choice to oppose the prior iteration of the AHCA was a signal that he, like many members, viewed a vote for the bill as a threat to his political survival.
There’s little reason to expect this new version, which could eviscerate protections for people with preexisting conditions, would be less of a threat.
Moderate Republican OH in the Capitol just now: "If I vote for this healthcare bill it will be the end of my career"
— Scott Wong (@scottwongDC) April 26, 2017
They should be afraid. The story will be that the bill was changed to placate extremists who want to hang sick people out to dry – and that these members went along with it.