Though House Republicans have resumed talks on a plan to repeal and replace the Affordable Care Act, they have yet to reach any decisions and are unlikely to bring a bill up for a vote before the Easter recess.
Members of the conservative House Freedom Caucus, the Republican Study Committee and the moderate Tuesday Group met with Vice President Mike Pence and other Trump administration officials on Tuesday night, Reuters reports. They emerged saying they had made progress but did not have any bill text ready.
The renewed push to settle on an ACA repeal and replacement bill comes after GOP leaders were forced to pull their initial legislation, the American Health Care Act, after failing to win enough votes from hardline conservatives.
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House Freedom Caucus Chairman Mark Meadows told reporters after the meeting that the talks centered on an amendment to the bill that would create a “backstop” to ensure individuals in high-risk insurance pools don’t see unaffordable premiums, the Reuters article notes. That plan would direct more funding to a $115 billion state stability fund already proposed in the AHCA.
Another Freedom Caucus member, Rep. Andy Barr, said the group’s members were looking to Maine’s risk-pool setup as a model that moderates and conservatives might agree on, The Wall Street Journal reported. But Meadows noted there is less agreement about whether to keep the ACA’s “guaranteed issue” requirement, which requires insurers to cover anyone who applies, regardless of health status, the article added.
Another potential compromise on the table is allowing states to opt out of the ACA’s “community rating” rule, which effectively bars insurers from requiring people with pre-existing conditions to pay higher premiums, according to Politico. Without that rule, the ACA’s guaranteed issue requirement would essentially be meaningless.
If there is guaranteed access to insurance without community rating, protections for people with pre-existing conditions are illusory.
— Larry Levitt (@larry_levitt) April 4, 2017
Already, some moderate Republicans were expressing concern about erasing that ACA rule, with Tuesday Group member Rep. Tim Murphy telling The New York Times that “I don’t think we will have something that eliminates community rating.”
A report released by the Obama administration in January credited the ACA’s protections with helping reduce the uninsured rate for those with preexisting conditions by 22% between 2010 and 2014. And a Kaiser Family Foundation analysis warned that a return to pre-ACA underwriting rules would result in millions of people becoming uninsurable in the individual markets.
Meadows and other conservatives, however, argued that it is smarter to move the seriously ill to high-risk pools in order to offer lower premiums to everyone else, according to The Hill.