The AHCA and The Moderate Objection to Trumpcare

After the American Health Care Act (AHCA) was tabled in March due to outcry from both Democrats and rightwing Republicans, Congress began tweaking the plan in an effort to get the bill to the floor before President Trump’s 100th day in office. The push was to make good on a campaign promise made by the president that he would take steps to repeal the Affordable Care Act (ACA), more commonly known as Obamacare, in his first 100 days. However, Congress did not meet the deadline as the AHCA even in its revised form did not garner enough support to bring it to the floor.

MacArthur Amendment

On April 25, 2017, moderate Republican Tom MacArthur released an amendment to the bill designed to placate conservatives who felt that the original AHCA did not go far enough to repel portions of Obamacare that they felt were damaging to consumers. The MacArthur amendment would allow states to apply for a waiver that would enable insurance companies to ignore some of the regulations created by Obamacare if they could demonstrate that not offering those services would lower costs. Highlights of the amendment include the following:

  • States could define their own essential healthcare benefits and eliminate some of the baseline benefits provided for under Obamacare, such as maternity care and emergency room visits, if they can demonstrate that elimination of those benefits would lower costs.
  • States could create invisible high-risk pools for enrollees with pre-existing conditions, a departure from the Obamacare requirement that insurers must charge the same for enrollees whether they have a pre-existing condition or not.
  • The Department of Health and Human Services would be required to deny any state waiver within 60 days. If it fail to do so within 60 days, the state waiver would be approved by default.

The law would not allow a waiver to limit access to those who have pre-existing conditions, but does not make it clear what the funding baseline would be. In other words, while it’s not clear how this amendment would impact health insurance, it should be noted that protection for coverage of pre-existing conditions remains part of the healthcare bill.

House Freedom Caucus

The amendment led the House Freedom Caucus, which did not support the original version of the AHCA, to support the new law and to back the legislation, adding support from as many as 20 representatives who were not prepared to vote for the bill in its original form. The Freedom Caucus consists of approximately 35 House Republicans, and their lack of support contributed to the original bill being pulled from the floor. Other conservative groups, including the Club for Growth and the Heritage Action for America, have come out in support of the bill with the addition of the MacArthur amendment.

Moderate Republicans

Although these recent changes have encouraged far-right Republicans to get on board with the AHCA, the amendment has not been accepted widely by moderate members of the GOP. Moderates in the House have been relatively quiet about their views on the bill, but many chastised members of the Freedom Caucus for rejecting the first version of the bill in March. However, those who have spoken out say that the amendment does not address the things that moderate Republicans were concerned about. Representative Dan Donovan said that he felt the amendment was detrimental to his constituents while Representative Leonard Lance said that he would only support a plan that lowers premiums and increases access and that the Congressional Budget Office score says will achieve those goals. Representative Mario Diaz-Balart said that the amendment threw up a lot of “red flags” and that he was undecided on how he would vote on the new version despite being a firm yes on the previous version. As of April 28, 2017, 17 Republicans are firmly against the bill, 10 are leaning toward no, and 11 are undecided.

Votes to Pass

In March, the AHCA bill was pulled when nearly every member of the Freedom Caucus announced that he would vote against the legislation. This meant that Republicans did not have the votes necessary to pass the bill from the House to the Senate. The addition of the MacArthur Amendment will push the bill closer to passage, but it is still not clear if there are enough votes since some moderates have spoken out against the recent changes.

It’s likely that enough moderates will be on board to push the legislation through since up to 22 Republicans can vote against it and it will still pass. However, the AHCA faces an even harder battle for passage in the Senate. If every Democrat votes against the bill, something that is expected, Republicans cannot have more than two moderate Republicans vote against it or the bill will fail in the Senate.