The Republican Obamacare Replacement Bill Is Back. But Maybe For Real This Time

The hardline conservative Freedom Caucus officially endorsed the new GOP health bill, leaving it up to moderates to support the legislation or kill it on their own. One moderate leader calls the whole thing merely an exercise in shifting blame away from conservatives.

The once dead and buried Obamacare repeal and replacement bill has new life after the far-right Freedom Caucus endorsed the newest version of the bill. The endorsement could be enough for Republicans to pass a bill to scrap the Affordable Care Act through the House.

It’s the first major breakthrough since Republican leadership had to withdraw their American Health Care Act ahead of a doomed House vote last month.

The Freedom Caucus took heat from President Donald Trump when they refused to support the initial AHCA, but it appears to have paid off in the end.

The new bill pulls the AHCA farther right and potentially eliminates even more tenets of Obamacare, just as the Freedom Caucus wanted. The new bill would allow states to waive Obamacare rules such as the ban on charging people with pre-existing conditions higher premiums and essential health benefits, or the minimum requirements for what health insurance plans must cover.

The new version maintains the original plan to cut Medicaid funding and substantial Obamacare taxes, gut federal funding for Planned Parenthood, and allow people to forego buying insurance at the risk of facing higher premiums.

The bill’s fate now rests in the hands of Republican moderates who could pass or kill the amended AHCA in the House. They’re in a particularly tough spot because the new draft comes not from a hardline conservative, but from one of their own.

New Jersey Rep. Tom MacArthur broke ranks from the moderate Tuesday Group and worked with the Freedom Caucus to draft the new amendment which includes the Obamacare waivers.

Republicans had promised since the 2016 campaign season not to revert to the old days when chronically ill people were priced out of the insurance market. The MacArthur amendment addresses this by forcing states opting out of Obamacare protections to fund high-risk pools instead in order to treat the most expensive patients.

Using these waivers would be up to the states, and the amendment says states must first show that adopting the waivers will lead to more people getting health coverage. But Freedom Caucus members said after earlier meetings that the White House had expressed it would be lenient in allowing states to use the waivers.

Still, a vote for the bill will give Democrats a new arsenal of attack points about broken promises to use in future elections. Moderate Republicans must now choose between supporting the bill and taking that election risk, or voting down the bill and being blamed by their president and the rest of their party for allowing the health care bill to die again.

One Tuesday Group member said he enough moderates will oppose the bill that it will fail. But publicly, most members kept their hands to their chests Wednesday. Many said they needed more time to study the amendment. Some who supported the previous GOP health care bill, such as Colorado Rep. Mike Coffman, said they were now undecided.

MacArthur ran away from reporters and refused to answer questions about his amendment Wednesday afternoon. But Tuesday Group co-chair Rep. Charlie Dent said the whole exercise is not really about fixing health care, but shifting blame off of conservatives.

“We know that this bill, in its current form, with or without the amendment, will be gutted in the Senate. So this is simply a matter of blame-shifting and face-saving,” said Dent.

Dent opposed the previous AHCA and said the new amendment makes the bill even worse. He argues the bill hurts states that adopted Obamacare’s Medicaid expansion, does not provide sufficient coverage for low-income Americans, and wrongly strips funding from Planned Parenthood. Asked if he was surprised that a Tuesday Group remember was behind an amendment that pulled the bill to the right, he responded, simply, “yeah.”

The MacArthur amendment initially exempted members of Congress and their staff from the Obamacare waivers under the new AHCA. Congressmen and staff would be exempted from having their insurance plans weakened (if their state waived essential health benefits) or being charged more if they were sick (if their state waived community ratings, which protected people from having their personal health history play into their insurance rates.)

But after a Vox story exposed the exemption, Republicans quickly backtracked. MacArthur announced by midday that the exemption would be removed from the final draft of the amendment and members of Congress and their staff would be subject to the same health care rules as other Americans.

If Republicans do indeed have the votes this time, the new AHCA could go before the House for a vote as early as next week. It would then still need to go through the Senate, where it will likely face a similarly rocky path.