As Senate Majority Leader Mitch McConnell seriously considers a proposal that would move his healthcare bill further to the right, he faces a familiar conundrum: Appeasing conservatives would likely cost him the support of moderates.
The proposal in question is one first floated by Sen. Ted Cruz, R-Texas, which would allow insurers to offer non-ACA-compliant plans in any given state if they also agree to offer at least one ACA-compliant plan in that state.
In a sign that the provision could very well make it into a revised bill, McConnell has asked the Congressional Budget Office to analyze how it would affect insurance coverage and the federal budget, Senate GOP aides told The Wall Street Journal (sub. req.).
The proposal already has the support of conservative Reps. Jim Jordan of Ohio and Mark Meadows of North Carolina, the article added. In addition, prominent conservative groups FreedomWorks and the Club for Growth are backing the proposal, as is White House legislative affairs director Marc Short, according to Politico.
Under such a proposal, young, healthy consumers would gravitate toward the skimpier, non-ACA-compliant plans, forcing those who need more comprehensive coverage into a de facto high-risk pool, as FierceHealthcare has reported. The effect could be lower premiums for some consumers, health analysts told the WSJ, but could also create sky-high rates for individuals with pre-existing conditions.
Similar concerns arose about the House’s amendment to its bill, which would let states opt out of the Affordable Care Act’s community rating provision that bars insurers from charging sicker customers higher premiums.
Many Senate Republicans are leery of eroding protections for those with pre-existing conditions after watching the House's struggle with the issue, Politico noted. Indeed, GOP senators like Sen. Lamar Alexander of Tennessee and Sen. Deb Fischer of Nebraska have already spoken out against Cruz's proposal.
Sen. Susan Collins, R-Maine, is also not sold, according to The New York Times. “I believe it would lead to adverse selection in the marketplace,” she said.