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Republicans have a new plan to revive their overhaul of the healthcare system, and it may bring the party closer to passing their bill.
An amendment to the American Health Care Act, offered by Rep. Tom MacArthur of New Jersey on Tuesday night, appears to satisfy many demands made by conservatives in the House GOP conference that originally sank the bill. Questions remain, however, over the ability to get moderates on board.
The new plan is broadly similar to the rough outline leaked Thursday. It opens the possibility of allowing states to opt out of two of the biggest provisions of the Affordable Care Act, the healthcare law better known as Obamacare.
Here's a quick rundown of the key provisions of the amendment:
- Allows states to waive essential health benefits: Under Obamacare, health-insurance plans are required to cover a baseline of health benefits such as maternity care and emergency-room visits. Under the new amendment, states could define their own essential health benefits if they show that doing so would cause prices to decrease. This could allow states to eliminate some of the baseline benefits in the AHCA since covering fewer benefits would allow insurers to offer cheaper plans, but it could also result in slimmer plans and less care for people enrolled.
- Allows states to waive aspects of the community rating: Under Obamacare, community-rating rules make it so insurers must charge the same price to consumers in a certain area regardless of gender, preexisting condition, and other factors. Under the AHCA's new amendment, states could get around this rule if they provided some funding for people with preexisting conditions to get coverage, participate in the "invisible high risk pools" established by the AHCA, or "provide incentives to appropriate entities" to "stabilize premiums." While the bill says the waiver cannot limit access to people with preexisting conditions, it is unclear what the baseline of funding would be to grant this waiver. Therefore, people with preexisting conditions could still end up having higher costs.
- Default approval: States requesting a waiver would have to be denied within 60 days of notifying the Department of Health and Human Services. If the HHS does not explicitly deny the waiver request, it is approved. This would allow the Trump administration to decide how rigorous the process would be for states.
Still not a slam dunk
These new provisions have been key sticking points for the conservative members of Congress who originally prevented the plan from making it to a vote.
After the text of the bill was released Tuesday, numerous conservatives came out in favor of the amended AHCA.
"It’s pretty much everything I was looking for in terms of concessions," Rep. Scott DesJarlais, a member of the conservative House Freedom Caucus, told Bloomberg.
Numerous other Freedom Caucus members came out in support of the amended bill, and the group's chair, Rep. Mark Meadows, told reporters after a meeting at the White House that he was "optimistic" about the plan.
Rep. Gary Palmer also told the news website Axios "we're really close, if not there," on getting enough votes to pass the bill.
But questions remain as to whether the AHCA has enough support from more moderate members of the party. Moderate GOP members were already concerned about concessions to conservatives regarding some of the essential health benefits and protections for preexisting conditions.
Rep. Charlie Dent, a key moderate member of the House GOP, told the Washington Examiner that even with the MacArthur amendment he was against the AHCA.
"Based on what I've read, it does not change my position," Dent said Tuesday. "I was a no, and I remain a no."
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