Will Pence, Paul deliver on ObamaCare repeal after a mulligan?

It looked like Republican infighting drove ObamaCare out of bounds two weeks ago, but it might have gotten rescued by a few chip shots on Sunday. Sen. Rand Paul, a vociferous critic of the American Health Care Act and ally of the intransigent House Freedom Caucus, played a round of golf with President Donald Trump and OMB director Mick Mulvaney two days ago — and suddenly declared himself “very optimistic” about a deal to pass the AHCA after all.


Now, the Washington Examiner reports that the deal could be announced as early as today, even if it takes a week or two to get it passed:

The White House is expected to release the text of a new deal on Tuesday that would give states the power to opt out of certain Obamacare insurance mandates, in a major attempt to revive Obamacare repeal as early as this week.

Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, told reporters after meeting with Vice President Mike Pence and White House officials that he expects the text of the new compromise on Tuesday. But Meadows seemed doubtful on whether the House would vote this week before adjourning Thursday for the two-week Easter recess.

The bill could pass as soon as it’s written. When House Speaker Paul Ryan pulled the AHCA vote off the calendar, it still left the bill eligible for a final floor vote at any time. Ryan could have it up for a vote before the ink’s dry on the pages, so to speak. (Does anyone use wet ink processes any more?)

However, the bigger conflict might be the expiration of the continuing resolution at the end of April, which will require an omnibus spending bill or another CR to keep government in operation. With the two-week recess for Easter, there’s not much floor time for anything else except budgets at the moment. And the longer this compromise goes, the more likely it will be to fall apart — and then it still has to pass the Senate, although Rand Paul’s blessing on it may be enough to get to 50-plus-Mike Pence.


Speaking of whom, the Washington Post gives Pence the credit for leading the effort among reluctant conservatives. But what exactly does the compromise entail?

Pence, Chief of Staff Reince Priebus and Budget Director Mick Mulvaney came to Capitol Hill late Monday to attend a meeting of the hard-right House Freedom Caucus, days after President Trump launched a remarkable intraparty attack on the staunch conservatives who helped block the bill last month. …

Rep. Mark Meadows (R-N.C.), the chairman of the Freedom Caucus, told reporters Monday night that the administration officials offered a “solid idea” that could form the basis of an intraparty compromise.

That idea, he said, would allow states to apply for federal waivers exempting them from some health insurance mandates established under the Affordable Care Act — including “essential health benefits” requiring coverage of mental-health care, substance abuse treatment, maternity care, prescription drugs and more, as well as a provision that bars insurers from charging the sick more than the healthy.

One hang-up will be whether to overturn the “community rating” mandate in ObamaCare, which conservatives have rightly argued drives prices up so high for everyone as to make insurance worthless. They want insurers to return to pricing risk properly in order to encourage healthy people to return to the insurance markets, but that could leave people with pre-existing conditions out in the cold. Meadows points out that the $115 billion stabilization fund within the AHCA could be used to alleviate that problem:


However, the community rating mandate was a key driver for ensuring coverage for people with preexisting conditions. Without the mandate, insurers could charge people with preexisting conditions exorbitantly high prices, making coverage hard to achieve. A community rating, which forces insurers to charge the same rate throughout a geographic area, would ensure that insurers couldn’t charge a person with preexisting conditions.

Meadows said that a $115 billion stability fund that was already part of the bill that failed in March, spread out among states, could help offset any such major spikes for people with preexisting conditions. States can decide how to use the funding given to them and can use it for risk sharing.

For the last two weeks, Republicans have formed a circular firing squad over the AHCA. For the moment, they’ve put down their guns and are at least improving into a debating society. That’s a pretty good outcome for a round of presidential golf — and a lot more productive use of that time than has been seen in several years.

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