Pushing for Vote on Health Care Bill, Trump Seems Unclear on Its Details

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Which bill Mr. Trump was referring to is not clear. Since the first version of the American Health Care Act failed to win enough House support on March 24, revisions to win over the conservative House Freedom Caucus have undermined protections for the sick. The conservatives finally endorsed the legislation last week after House leaders revised it to permit states to opt out of several mandates in the Affordable Care Act.

States could, for example, allow insurers to provide a more limited package of health benefits than the Affordable Care Act requires. With a waiver, states could also allow insurers to charge higher premiums to people with pre-existing conditions, if states had an alternative mechanism such as a high-risk pool or a reinsurance program to provide or subsidize coverage for people with serious illnesses.

But such high-risk pools did not always work well before the Affordable Care Act’s outright ban on discriminating against people with pre-existing conditions took effect.

Mr. Trump appeared to be unfamiliar with details of the amendment that would allow states to obtain a waiver permitting insurers to charge higher premiums based on a person’s “health status.”

Nor did he explain how the Republicans’ new health plan would produce “much lower premiums.” In its analysis of the last version of the repeal bill, the nonpartisan Congressional Budget Office said that average premiums in 2018 and 2019 “would be 15 percent to 20 percent higher under the legislation than under current law.” By 2026, it said, average premiums would be roughly 10 percent lower than under current law.

How the revisions might effect those figures — or the estimated 24 million more Americans who would lack insurance under the original bill after 10 years — may not be known when the House votes on the new version. Representative Chris Collins, Republican of New York and a top Trump ally, said Republicans were not planning to seek a new cost-and-impact estimate from the Congressional Budget Office.

Representative K. Michael Conaway of Texas, who counts votes as a member of the Republican whip team, said he thinks Republicans will be able to get the votes needed to pass a repeal bill in the House this week.

Mr. Trump said the bill had changed substantially since efforts to pass it collapsed in March, in a humiliating setback for him and House Republican leaders.

But he said the bill’s approach to people with pre-existing conditions had been misreported.

“When I watch some of the news reports, which are so unfair, and they say we don’t cover pre-existing conditions — we cover it beautifully,” the president said.

The amendment, offered by Representative Tom MacArthur, Republican of New Jersey, with the blessing of House Republican leaders, says, “Nothing in this act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with pre-existing conditions.”

But the amendment also says that the federal government can grant waivers allowing insurers to consider “health status” as a factor in setting rates. Rates for a person with cancer, diabetes or multiple sclerosis could be far higher than the standard rate, effectively pricing the sick out of the market without technically blocking coverage, critics say.

“Health status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions,” the American Medical Association said in a letter urging members of Congress to oppose the latest version of the repeal bill.

The possibility that Republicans would muster a majority for the repeal bill set off alarms among supporters of the Affordable Care Act. Topher Spiro, the vice president for health policy at the liberal Center for American Progress, declared a “red alert” on Sunday, saying on Twitter, “Only a TIDAL WAVE of calls tomorrow can stop them.”

Groups that formed to resist Mr. Trump’s agenda and had mobilized against the Republican repeal vote last month are doing so again. Particularly in districts represented by moderate Republicans, protest groups have organized emergency rallies outside congressional district offices and sent out action alerts asking people to “call, call, call” their representatives, in the words of one organizer of the group NJ 11th for Change, which since January has been lobbying Representative Rodney Frelinghuysen of New Jersey, the chairman of the powerful House Appropriations Committee, to protect the Affordable Care Act.

Valerie Fleisher, an organizer of 412 Resistance, a protest group in the congressional district outside Pittsburgh, said that her group had remained on high alert about the possibility of Republicans trying again to repeal Obamacare, even after Mr. Trump said the party would move on.

“We were actually more concerned when it didn’t come up for a vote last time because that meant there was no room for compromise at the middle,” she said. “It would have to move more to the extreme, more to the right, to get the votes that it needed from the Freedom Caucus.”

House leaders said last week that the White House was pushing for a vote on the repeal bill to show progress on one of Mr. Trump’s most significant campaign promises by Saturday, his 100th day in office.

But Mr. Trump denied that. “We really have a good bill,” Mr. Trump said on “Face the Nation.” “I think they could have voted on Friday. I said, just relax. Don’t worry about this phony 100-day thing. Just relax. Take it easy. Take your time. Get the good vote and make it perfect.”

Continue reading the main storySource: New York Times – Politics

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