The White House prodded House Republican leaders to make last-minute tweaks to their Obamacare replacement bill Thursday aimed at protecting high-cost patients before lawmakers leave Washington for their two-week spring break.
The changes would create a subsidy for insurers that cover sick, expensive patients and could help revive Republican lawmaking efforts to repeal and replace large parts of the Affordable Care Act. They also echo a key program under Obamacare, which like the GOP proposal, uses subsidies to lower premiums.
Called the Federal Invisible Risk Sharing Program, the Republican proposal would give health insurers $15 billion over nine years to subsidize the care of high-cost patients. It’s similar, though less generous, than Obamacare’s three-year-long reinsurance program, which gave insurers $7.9 billion for 2014 and $7.8 billion for 2015, according to data from the Kaiser Family Foundation, and is intended to pay out $4 billion for 2016.
The effect of the GOP proposal on premiums would be minimal, said Matt Fiedler, a fellow at the Brookings Institution’s Center for Health Policy. If all of the subsidies were passed through to consumers, premiums would be about 1 percent lower.
Lawmakers are leaving Washington Thursday afternoon for their annual two-week legislative break without voting on the overall bill.
House Speaker Paul Ryan told reporters Thursday that the change to the Republican legislation “makes this a much better bill,” adding that, “This amendment alone is real progress, and it will help us build momentum toward delivering on our pledge to the country” to repeal and replace Obamacare.
Efforts to replace the Affordable Care Act have caused worry for insurers, who aren’t sure about the law’s future or what would replace it. On Thursday, Aetna said it would pull out of Iowa’s Obamacare market, becoming the second major health plan to do so this week after Wellmark said it was quitting the state as well.
“Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace,” spokesman T.J. Crawford said in an email Thursday. “We are still evaluating Aetna’s 2018 individual product presence in our remaining states.”
The House Rules Committee is meeting to consider the measure and add it to the health bill, which was pulled from a floor vote in the House last month after it became clear that Republicans, who control the chamber, didn’t have enough votes among their various factions to pass the measure.
The effort by the Rules Committee to rush to adopt an amendment to a bill—without much time for anyone to read it or any immediate intent to take the measure to the House floor—is highly unusual, but it reflects the strong desire by the White House to demonstrate that the effort to repeal Obamacare isn’t dead. The provision is sponsored by Reps. Dave Schweikert of Arizona and Gary Palmer of Alabama, both members of the House Freedom Caucus, the conservative group that has been blamed for blocking a deal on a final bill.
While the amendment “was offered by two of our most conservative members,” it is embraced by a broad part of the Republican conference, Ryan said. Lawmakers will continue working on further revisions, he said.
The GOP proposal would give Health and Human Services Secretary Tom Price broad authority in determining how the payments are handed out, including which patients insurers would be reimbursed and for how much. Many aspects of the program would have to be worked out by HHS and aren’t detailed in the four-page amendment. In 2020, its operation would be handed over to the states.
“It’s as if Congress wanted to reinstitute the risk corridor and reinsurance programs, but couldn’t bring itself to use those words,” Nicholas Bagley, a professor at the University of Michigan’s law school who studies healthcare and regulation, said on Twitter.
Obamacare's much larger reinsurance program lowered premiums by about 10 percent in 2014, according to a February 2016 estimate from the Congressional Budget Office. CBO estimated the effect would wane as the reinsurance amounts got smaller.
While some members of the Freedom Caucus support Thursday’s amendment, they won’t commit to casting a yes vote until they see the legislative text of what Vice President Mike Pence offered the group on Monday, according to two aides close to the far-right group.
That includes a waiver for states that would let them out of federal requirements on what benefits insurers have to cover. That would likely lower premiums but also decrease consumer protections. Conservatives have also discussed eliminating what are known as community rating rules, which prevent insurers from varying premiums within a geographic area based on certain factors, including health status.
Yet it wasn’t clear after another late-night meeting on Tuesday with Pence and a broader group of Republicans that the White House is committed to structuring the waiver in a way that conservatives say would bring down the price of premiums, according to one of the aides. No decision will be made until they see the proposed changes in writing, rather than just a verbal offering, the aide said. Those changes hadn’t been made as of Thursday afternoon’s Rules Committee meeting.
Democrats slammed the potential changes, as well as the last-minute nature of the process.
“That does nothing to diminish the horror of their bill,” said House Minority Leader Nancy Pelosi of California.
Rep. Jim McGovern (D-Mass.) called the changes a last-ditch effort that had been concocted behind closed doors. At the Rules Committee session, he said the amendment was “just a couple of good ol’ boys with a typewriter saying, ‘Maybe this will work.’ I guess what Republicans want is something to point to before the two-week recess.”
Yet it may help Republicans finally gather their members behind the measure. Freedom Caucus Chairman Mark Meadows of North Carolina said Thursday morning at an event hosted by Politico that if the offers made over the last few days are in the final bill, then “the majority, if not all of the Freedom Caucus will vote for this bill.” He called the risk subsidy provision “a step in the right direction, but certainly not the final step.”
Congressional staff will keep working on healthcare bill during the Easter recess, and could change it more to try and gain votes, said AshLee Strong, Speaker Ryan’s spokeswoman. She said leadership is aware of where opposition and support lie, and are trying to convince lawmakers in the middle. She also raised the possibility that Congress could return earlier than scheduled if they have the votes to act.
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