You didn’t think this fiasco would end without a Republican version of Pelosi’s “pass the bill to find out what’s in it” remark, did you?
“In my district right now there’s a lot of misunderstanding about what it is we’re doing,” says Rep. Chris Collins below in defense of the bill. Okay, but there’s also a lot of misunderstanding among Republicans about what they’re doing. Your must-read of the day is this wonky but important blog post by Nicholas Bagley on unintended consequences from the new amendment to the GOP health-care bill. One of the Freedom Caucus’s latest demands, remember, was adding something to the bill that repeals the ObamaCare regulations requiring insurers to provide certain “essential health benefits” in all plans. Get rid of those federal rules governing EHBs, conservatives say, and let the states define them for themselves. Then insurers will be able to offer cheaper, more tailored insurance. “Fine, whatever,” said the White House. “Write it up.” So someone wrote it up quickly, hoping that this would finally be the concession that gets the bill through.
Problem is, when you care less about what’s in the bill than about simply getting something passed, key details tend to slip through the cracks. Bagley:
[T]he amendment tells each state to define what counts as essential within the state, “for purposes of section 36B of the Internal Revenue Code.”
State-defined benefits will then drive the size of the tax credits: the more expansive the benefits, the bigger the tax credit. Did House Republicans really want to give states an incentive to expand the definition of essential health benefits in order to draw down more federal dollars? As Tim Jost points out, this problem dissipates in 2020, when the tax credits will be fixed amounts that don’t turn on which benefits are essential. But the concern is very real for 2018 and 2019.
Even if you think that’s good policy, the manager’s amendment is troubling. Start with its irresponsibility. The new rule would apply as of January 1, 2018. But insurers have to create and price their health plans within the next few months in order to get them approved prior to the start of open enrollment. They don’t know which services their states will say are essential and they don’t have time to wait around while their states bicker about it.
Chaos — and it doesn’t end there. What happens if a state doesn’t define “essential health benefits” before January 1st? Under the law as amended by the GOP bill, tax credits are available to consumers to help them purchase a plan only if their plan contains EHBs; thus, if a state doesn’t act quickly to enact some EHBs after the Republican replacement plan is enacted, its entire population might end up being shut out of those credits. Insurers might avoid offering plans in that state altogether for fear that if they do and a court later rules that consumers there are ineligible for tax credits, suddenly hundreds of thousands of people would be unable to afford their premiums, triggering a market collapse. In fact, per Bagley, the Republican amendment doesn’t even make clear whether states, in setting their own EHBs, would be bound by the same rules that HHS is bound by under ObamaCare (offering maternity leave, etc) or whether they’d be completely free to make their own rules.
These are … important details, worthy of considered debate, yet the amended bill seems to be making things more, rather than less, confusing. And it’s a total question mark how many House Republicans are even aware of these problems. How can they have an informed opinion on a bill that’s still being written? Sad to say, this snark from HuffPo’s Sam Stein is a fair summary of the state of play:
We don’t have legislative language for you
We don’t have a CBO score for you
This thing polls at 17%
The Senate won’t pass it
— Sam Stein (@samstein) March 24, 2017
The best counterargument to Bagley is the one Quin Hillyer made last night: This isn’t a final bill. Literally no one expects it to pass the Senate in this form, assuming that anything passes the Senate at all. Just rubber-stamp something in the House, move the ball to McConnell’s court, and wait to see what comes back. Bagley’s concerns will be ironed it in conference committee, if and when one happens. That’s compelling logic, but remember that no matter if the bill passes or fails, House Republicans who vote yes on this thing today will be held to account for it by Democrats in 2018. And I wouldn’t be so sure that details like this will be ironed out later in conference. The attitude of Republicans from Trump to Ryan to McConnell to the rank and file seems to be that they want this process over with as soon as possible so that they can move on to more popular agenda items. Whatever comes out of a conference committee might also be hastily slapped together in the name of checking this box and moving on.
The buzz on the Hill as of noon ET is that the bill is going down, and maybe not by a close margin. Within the past hour, GOPer Rodney Frelinghuysen announced he’ll be voting no — a very big deal, as Frelinghuysen is the chairman of the House Appropriations Committee and normally wouldn’t risk his chair by opposing the leadership on a major bill. (“In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues.”) If it looks like the Freedom Caucus has the votes to kill the bill, dozens of moderates will seize the opportunity to vote no as well and rid themselves of this albatross, meaning that if the bill fails, it may fail by a landslide margin. As of now, the floor vote is scheduled for somewhere around 3 or 4 p.m. ET. Stay tuned.