For the last several weeks, the White House has been working with uber-conservative Freedom Caucus chairman Mark Meadows and the comparatively centrist Tuesday Group leader Tom MacArthur to come up with a repeal-and-replace plan to the Affordable Care Act that would earn the support of both wings of the Republican Party. On Thursday, the Freedom Caucus announced its official support for the so-called “MacArthur amendment,” signaling that 80 percent of its members would vote for the revised American Health Care Act. The new amendment would allow states to obtain waivers exempting them from two key protections in the ACA: the requirement that insurers cover a package of 10 “essential health benefits”; and the requirement that insurers not charge people with pre-existing conditions higher premiums, otherwise known as the community ratings provision. (States that opt out of the community rating requirement would have to maintain a high-risk pool for those with pre-existing conditions.)
Freedom Caucus endorsement aside, moderates are skeptical of this new AHCA. CNN reports that Charlie Dent, another Tuesday Group leader, remains still publicly opposed to the revised health-care bill, as do a number of other moderates.
Let’s just take a step back for a moment to review. The AHCA failed because of opposition from Freedom Caucus conservatives, who felt it didn’t go far enough in repealing the ACA’s insurance market regulations, as well as moderates, who were worried about the estimated 24 million people who would lose health insurance. And that was all under the old version of the AHCA — before the White House started negotiating with the Freedom Caucus and moderates fled en masse.
The MacArthur amendment doesn’t address moderates’ concerns about the original AHCA in any meaningful way. It doesn’t solve the issue of the tax credits being insufficient, especially for low-income, older Americans in high-cost areas; it doesn’t do anything to put the minds of moderates in Medicaid-expansion states at ease; and while it’s perhaps a slightly better outcome for moderates than the complete elimination of the essential health benefits and community ratings provision, it will clearly leave many people with pre-existing conditions at risk of losing access to health insurance. The Congressional Budget Office hasn’t yet scored the amendment, but it’s difficult to see how it wouldn’t result in even more people losing health insurance than under the original bill.
What’s more, recent polling suggests that the changes proposed by the MacArthur amendment are wildly unpopular, even among Republicans and Donald Trump voters, a fact that isn’t likely to thrill moderate Republicans in swing districts. That is all to say: It’s hard to see how this amendment will solve the GOP’s health-care dilemma.