Apr 4, 2017

GOP leaders worried about Trumpcare and pre-existing conditions

Alex Brandon / AP

House Republican leaders are worried that a concession in the developing Trumpcare talks could make already anxious moderates run away from the bill. The proposal is to allow states to get rid of the "community rating" provision that prevents insurers from charging higher rates to sick people.

Why it's a problem: Most Republicans have been adamant that they're going to keep covering people with pre-existing conditions (as has President Trump). It's one of the most popular parts of Obamacare. But without the "community rating" provision, insurers could jack up the premiums for people with health problems — and make it so expensive that they lose coverage because they can't afford it anymore.

  • A leadership source who has a good read of the conference says the deal could have a negative impact on more than just Tuesday Group (moderate) votes. The source's view is that touching community rating is harmful and allows the Freedom Caucus to ultimately shift blame away from themselves for the inevitable failure of the new bill.
  • This is something we keep hearing from Republican leadership and moderates: they don't want to let the Freedom Caucus say they've been reasonable and potentially convince Trump to cast the blame on Paul Ryan and the moderates.
  • The Democratic attack ads on pre-existing conditions write themselves: "If people can't afford their coverage, they're not covered," per a House Democratic leadership aide.
  • But conservatives have been targeting the provision a long time, because they're convinced it's one of the reasons individual health insurance has gotten so expensive.
  • For the Freedom Caucus / outside group perspective, here's an influential conservative leader: "Conservatives were right that regulations were linchpin of deal — Heritage Action and Freedom Caucus been pushing this since day one. Moderates should embrace it as federalism even if they like some of the regulations that get rolled back... This is very very far from full repeal, which means conservatives have given up A LOT, and the text of the White House needs to be legit to make it worth it."
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