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The new state of Trumpcare: Desperation

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Here's the big problem Republicans are facing on Trumpcare: They're facing so much pressure to pass a bill — any bill — that the changes have stopped being about improving the policies, or steering toward a broader, coherent vision of conservative health care reform. It's all about chasing votes now, and the more they try, the more the changes leave health care experts scratching their heads.

The latest as we head into the congressional recess:

  • Republicans have added a $15 billion "Federal Invisible Risk Sharing Program" to the bill to help insurers that attract a lot of expensive patients.
  • It's basically a rebranding of the reinsurance program Obamacare used to help insurers in its first years, though if you say that to the Republican sponsors, they will punch you in the face. There are some subtle differences. Tim Jost has a great deep dive into the new proposal at the Health Affairs blog.
  • The goal is to cover sick people without separating them into a high-risk pool, and to bring down premiums — which it could do, Jost writes, if it were funded with a lot more money.
  • Freedom Caucus chairman Mark Meadows said the provision "doesn't complete the task, but it's a good step in the right direction," Roll Call reports. But the group still wants to get rid of the pre-existing condition regulations, and it's not clear how much the new provision will do to lock up their support.
  • Why are we hearing about this right before the recess? Because the White House leaned on House Speaker Paul Ryan hard to show some progress, not just let everyone leave for two weeks, per Politico.
  • So Ryan put on a big show at his weekly press conference yesterday, loading up the stage with 30-plus Republicans as a backdrop to show unity on Obamacare repeal. "We have made real progress this week," he practically shouted.
  • The Rules Committee held an "emergency" meeting to approve the amendment — right before the recess, for a bill that wasn't about to come up for a vote. It's something I don't remember seeing in more than 20 years of covering Congress.

What the experts are saying: Conservative health care analyst Avik Roy says the risk-sharing fund shows "considerable progress" in improving the bill — though he says it needs more work on regulatory reform and aid to the low-income elderly. But Chris Jacobs, another conservative analyst, wonders why the fund wasn't tied to the state waivers the GOP also wants: "I could be missing something, but I don't see a coherent policy vision."

What's next: GOP leaders are under intense White House pressure to bring everyone back from recess to vote on the bill, but they won't do it unless there are signs that they're actually picking up votes. Ryan spokeswoman AshLee Strong: "Should a path toward 216 votes emerge, the speaker wouldn't hesitate to bring members back to fulfill our promise to repeal and replace Obamacare."

Bottom line: It's not likely right now — but don't make any travel plans you can't change.