Mar 24, 2017 - Health

The state of Trumpcare: Failure is an option

Greg Ruben / Axios

Here's the reality that President Trump and Republican leaders are facing: They want to repeal Obamacare, but not the popular parts of Obamacare. But to the most conservative Republicans, and their supporters, repeal means repeal — which includes everything, whether it's popular or not.

That's why Trump and GOP leaders haven't been able to close the deal with the Freedom Caucus, and will have to try to steamroller them with today's vote. It's why they have the Koch brothers after them. And it's why, barring a miraculous turnaround, they're not getting any closer to a deal that can survive the Senate as well as the House.

Here's where things stand as of this morning:

  • The House is voting on Trumpcare today, whether they have the votes or not. Why? Because Trump told them to.
  • Office of Management and Budget director Mick Mulvaney "made it clear that they were done negotiating, and this is a conservative package that lowers costs," House Ways and Means Committee chairman Kevin Brady told reporters last night. Jonathan Swan has great details of how Trump's ultimatum went down.
  • The big concession White House and GOP leaders are making to conservatives: They're going to get rid of Obamacare's "essential health benefit" requirements, which were untouched in the original bill. Under the new language, states would define them.
  • But the Freedom Caucus wanted to go beyond that, into the rest of Obamacare's insurance regulations — which include popular things like covering anyone with pre-existing conditions, making sure sick people can't be charged more, coverage of young adults, coverage of preventive care, and standards for how much of a person's medical expenses are covered.
  • If Trump and GOP leaders had agreed to wipe out the pre-existing condition coverage, they would have lost one of their main pitches for the Republican plan: Don't worry, sick people will still be covered. "I think that's been something that he's been very clear needs to stay in there," White House press secretary Sean Spicer told reporters.
  • But Freedom Caucus members and other conservatives say all of the insurance regulations make insurance more expensive — so to be consistent, they should all go. (Freedom Caucus member Mark Sanford's Obamacare replacement bill would deal with pre-existing conditions by giving sick people two years to enroll in coverage.)
  • The Washington Post reports that Freedom Caucus chairman Mark Meadows wanted to get rid of not just the rules against charging more for sick people, but also provisions that most Republicans have sworn they would never touch, like the ban on annual and lifetime limits on health benefits.
  • Meadows was still a "no" as of last night.
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