Council Foundation Logo Leaders Edge

April 26, 2017

In a dizzying week of legislative jockeying, a number of House Freedom Caucus members announced their support for an amended Affordable Care Act repeal/replace bill this afternoon. The news came after a couple of intense weeks of negotiating between moderate Rep. Tom MacArthur (R-NJ) and conservative Rep. Mark Meadows (R-NC), and a proposal that would give states greater flexibility in opting out of insurance regulations in the ACA. Through a federal waiver, insurers could be freed from a requirement to cover certain essential health benefits as defined by the federal government. And while they would still be required to cover people with preexisting conditions, they could charge those patients higher premiums.

The critical question today, however, is whether the agreement will pass muster with a growing chorus of moderate Republicans (the “Tuesday Group” caucus) who have doubts about the severity of cuts in subsidies and Medicaid spending, as well as objections to “continuous coverage” provisions that would substitute for the elimination of the pre-existing conditions restrictions of the ACA. Will Speaker Paul Ryan and his leadership team be able to muster the necessary 216 votes for passage of the amended proposal? They’re not releasing actual legislative text on the proposed MacArthur/Meadows compromise until House Republicans feel confident that they have enough votes to pass the bill, assuming once again (correctly) that not a single Democratic vote can be had on a repeal/replace bill.

The Council’s top legislative goal remains preservation of the employer-provided group health insurance marketplace. An early discussion draft of the Trumpcare bill would have scaled back the exemption from taxation for health insurance benefits, but GOP leaders dropped this proposal.

Council lobbyists Joel Wood and Joel Kopperud agree that even if the MacArthur/Meadows compromise were to succeed, Senate passage will remain an uphill climb. The 52-48 GOP majority means there is no room for error, and a sizeable bloc of moderate Republicans in the Senate would certainly look askance at many of the harsher contours of the current House bill.