President Trump and most of official Washington blames the House Freedom Caucus for the death of the American Health Care Act. There is some, but not complete, justification for this.
But the Freedom Caucus's top members have since laid out a clear path to passage or repeal and replace, and are showing a willingness to compromise. They have made a perfectly reasonable and prudent bid in the negotiation.
If the White House, Speaker Paul Ryan, and Republican centrists actually want to repeal and replace Obamacare, they should accept the Freedom Caucus's offer. If they reject it, it will demonstrate that they didn't mean it when they campaigned for election on a platform that included killing the 2010 law.
Caucus Chairman Mark Meadows laid out his conditions in an editorial board meeting at the Washington Examiner Thursday.
The Affordable Health Care Act repealed the employer mandate and the individual mandate. That's two of Obamacare's 12 mandates, by Meadows' count.
"The Freedom Caucus has asked for two [more] to be included in the repeal," Meadows said, "which would bring us to a total of four of the twelve Obamacare mandates. That's our ask: These Obamacare mandates repealed in exchange for Yes votes."
The Essential Health Benefits and "Community Rating" are the two regulations the Freedom Caucus wants dead.
Meadows said that with this change the legislation could probably win over most Freedom Caucus members. "With the text that actually repeals the two mandates, the EHBs and the community rating, it would bring the vast majority of the Freedom Caucus to yes"
This is a major concession. It means the Freedom Caucus is not demanding full repeal. It's allowing most Obamacare mandates to stay in place, in order to assuage centrists. A week ago, through an amendment that leaked out but never saw congressional action, the Freedom Caucus was asking for a repeal of the rule barring lifetime limits, among other deregulations.
"We have come from six requests down to two," Meadows said Thursday.
Meadows also said he can swallow the AHCA's refundable tax credits, which amount to federal spending and a new entitlement. "We got over that three weeks ago… We fully believe we're creating a new entitlement by doing that. That being said, our main goal, our only goal, is to lower premiums."
Axing EHB and community rating regulations are the way to lower premiums.
Obamacare's Essential Health Benefits regulation outlaws insurance plans that don't include sufficient coverage of a long list of treatments and services. This outlaws more affordable health insurance plans and forces people to carry more insurance than they want.
Centrists may balk at repealing these because Democrats get away with gross misrepresentation of the effect of this move.
Just because EHBs require coverage for ambulance rides doesn't mean you couldn't buy ambulance coverage if the regulations were repealed. First, other state and federal mandates on minimum coverage already exist. But even without mandates insurers, being businesses, tend to sell people products they want to buy. And if people want maternity coverage, they can buy maternity coverage. A thing need not be mandated to be available. It's the difference between "may" and "must."
"Community Rating" is the name for Obamacare's price controls on premiums. An insurer can't raise premiums on risky individuals without also raising premiums on less risky individuals. The result is that everyone's premiums go up.
"Every major healthcare policy expert says" those two regs "are the two that most drive healthcare premiums up," Freedom Caucus founder Jim Jordan said. "So you have to get those repealed."
These are sound requests. They would bring down insurance premiums and untangle some of the regulatory web Obamacare has woven. So the stage is set for an Obamacare replacement compromise: keep the tax credits from the first bill, keep most of Obamacare's mandates, keep the incomplete Medicaid reform. Just kill these two costly regulations.
But Republican centrists might not accept this deal. "We're talking about asking for a little over 15 percent of the Obamacare mandates to be repealed," Meadows said, "and we can't get a yes for that?"
"We're willing to give the moderates something they want, whether it's on Medicaid expansion or additional monies for perhaps something they say that was being pulled out. But in the end, the request is pretty simple: two of 12 Obamacare mandates."
"The narrative is out there that we've moved the goalposts," Meadows said. "Well, we have. We've moved them much closer so all they have to do is kick a little chip shot..."
The House Freedom Caucus has often been obstinate and sometimes wrong. This time, they're being flexible, and they are right on the substance. The Speaker and the president should take them up on their offer. If this still doesn't get 216 votes, then the problem isn't the stubborn conservatives, it's the supposedly reasonable centrists.