Perhaps Mike Pence’s diplomacy on Capitol Hill has paid more dividends than first thought. At a Politico Playbook event this morning, House Freedom Caucus chair Mark Meadows (R-NC) offered to “make news” on the American Health Care Act and ObamaCare repeal. If the final legislation includes the changes Pence brought from the White House, his group of conservatives would vote for its passage, Meadows says:
— POLITICO Playbook (@playbookplus) April 6, 2017
“Just to be frank, we’ll make news here this morning,” Meadows told Jake Sherman. “If those offers that were made over the last couple of days appear in the legislation, the majority — if not almost all of the Freedom Caucus — will vote for this bill.” The biggest issue for the HFC, Meadows insists, is that the final version of the AHCA has to bring down premiums immediately rather than wait for three or more years for the market to catch up. “The primary objective has been, will be, always will be lower insurance premiums,” Meadows explained. “If we don’t do that, we will have failed.”
The HFC wants a waiver for states on essential health benefits — which had already been offered prior to pulling the bill when moderates balked — and on guaranteed issue and community rating, with the exception of gender for the latter. Meadows is right about these problems; the combination of mandates on insurers and individuals partnered with community rating restrictions has so greatly distorted proper risk assessment that prices skyrocketed for everyone. If states want to impose those, let them — and let them deal with the backlash from their own electorates. Meadows wants that connected to federal supports for high-risk pools that will allow people with pre-existing conditions a way to gradually find normal health-insurance coverage, “to make sure that premiums don’t go skyrocketing for those who are sick.”
Yuval Levin wrote about “the waivers question” yesterday at National Review:
The devil will be in the details, and they will matter enormously here, but the general concept of returning regulatory power to the states through waivers that are connected to the bill’s spending measures is an interesting way to deal with the constraints Republicans confront and could have real promise. …
A lack of clarity, and of time for discussion, regarding all that seems to have contributed to some trouble this week, and it remains to be seen if anything will come together before members leave for the Easter recess. Something after the recess certainly seems more likely. And more time would be useful for more members to get familiar with these ideas and see what they think of them.
Some moderate Republicans have taken the waiver approach to be about simply eliminating community rating or ending protections for people with pre-existing conditions. But the members championing the waiver approach seem instead to have in mind allowing states to achieve that goal by other means than Obamacare’s particularly onerous form of community rating and its mandates—and requiring states to show that this would be their goal before they could get a waiver to do it. That hasn’t been clear to many Republicans, and exactly how to do it isn’t really clear to anyone.
Crucial matters like that have so far remained unresolved, and will have to be worked out if this approach is to get anywhere. It may well be that some of it doesn’t get fully resolved in the House but a bill that introduces the waiver idea nonetheless makes it out to the Senate sometime soon, where it might be further worked out. The introduction of this concept seems like a good development, and it may point the way toward further ideas that are also, in a sense, native to the constraints of reconciliation.
The trick for Meadows is pushing to get enough of this while leaving enough on the table to keep Republican moderates on board. Prospects for that haven’t exactly been stellar, but Meadows’ statement today might get them closer together sooner rather than later. Either way, Pence seems to be doing a better job at bridging these gaps than a Politico story suggested yesterday, and TPM finds that he’s become a trustworthy arbiter in the House. It beats negotiating in the press, anyway:
Meadows and other members of the Freedom Caucus said that they have developed a good relationship with the White House, particularly with Vice President Mike Pence.
Rep. Justin Amash (R-MI) said that he enjoys “whenever he spends time with us, and he’s been doing that a lot lately.”
Meadows explained that part of why the AHCA failed initially was because it was rushed through the House.
“When we read about a piece of legislation in your publication for the first time, it’s a problem,” Meadows told the Politico reporters moderating the discussion.
It’s too late to push this through before the recess, but Paul Ryan had better not wait too long afterward to get it through. Pence might have other agenda items to push in May.