Hopes that the House Republicans would reach a compromise that could allow them to vote on a plan to repeal and replace the Affordable Care Act before leaving town for recess at the end of the week -- never very realistic in the first place -- are fading as lawmakers appear unable to find enough common ground between the party’s hard right and its less doctrinaire members.
In a late-night meeting that dragged on for two hours Tuesday, members of the Republican conference appeared to make little substantial progress on the plan, meaning that lawmakers will likely have to go home and face constituents having failed to keep their promise to do away with President Obama’s signature domestic achievement.
The main problem continues to be the demands from the far-right House Freedom Caucus that any repeal bill must eliminate various requirements the ACA placed on health insurance providers who sell policies to consumers who receive government subsidies for their coverage.
Freedom Caucus members argue that the requirements, including coverage of “essential” health benefits and the premiums that are based solely on the age of the consumer and not health status, have driven up costs.
On Tuesday, the divide between the Freedom Caucus and Republicans who want to see some of the basic protections in the ACA kept in place appeared only to widen. Freedom Caucus members have been touting a plan that would devolve much of the decision-making to the states, through a system that would allow them to individually opt out of some of the law’s requirements.
Among the things the states would be allowed to opt out of is what’s known as “community rating.” That’s a system under which everyone in the same age cohort is charged the same amount for their insurance, regardless of whether or not they have a pre-existing condition.
The elimination of discrimination on the basis of a preexisting condition is one of the most popular elements of the ACA, and even the most conservative lawmakers are worried about getting rid of it outright. But it comes at a price for everyone who has to pay some of those costs, whether they're sick or not. But the elimination of community rating would do so through the back door by allowing insurers to raise premiums on people with preexisting conditions so much that they are effectively priced out of the market.
Members of the Freedom Caucus would like to shift sicker consumers onto state-run high-risk insurance pools subsidized by the federal government, in order to bring down costs for healthy people buying insurance on the open market. More moderate Republicans are balking at the plan, worried that it would have the effect of limiting coverage for vulnerable Americans.
Speaking to reporters after last night’s meeting in the Capitol, Freedom Caucus chairman Mark Meadows, of North Carolina, tried to put a positive spin on the negotiations, even as he was forced to admit that there was no real agreement within the Republican conference on how to move forward.
“There were no agreements tonight, and no agreements in principle, and certainly no agreements in terms of a foundation,” he said, according to The Washington Post. “There was a general agreement that the progress we’re making is certainly progress, and there are good discussions, but understanding that there’s a whole lot of things that we have to work out.”
The meeting included high-level representatives from the White House, including Vice President Mike Pence and Office of Management and Budget director Mick Mulvaney, as well as senior members of the House leadership team and representatives of the Freedom Caucus and the Republican Study Committee and the members of the more moderate “Tuesday Group.”
If there was a bright spot for the GOP, it was that members of the Freedom Caucus and the Tuesday Group were in the same room together. Reports earlier in the day suggested that some members of the more moderate wing of the party didn’t want to even bother discussing matters with their more hard-right colleagues.