A new deal to repeal Obamacare would let insurers charge more if states get a waiver, but it is not clear if the deal will be enough to sway centrist Republicans in the House.
The deal was outlined in an amendment to the American Health Care Act, an Obamacare repeal deal that was pulled last month due to insufficient support. The amendment would let states opt out of requiring insurers to cover essential health benefits such as maternity care or hospitalization.
The amendment would keep the requirement that insurers have to cover people with pre-existing conditions. However, it lets states opt out of a price control called community rating, which prevents insurers from charging people with pre-existing conditions exorbitant prices.
But there are some key caveats designed to entice centrists. For one, a state can't opt out of a community rating for gender, age or health status. Under Obamacare, a community rating forces an insurer to charge the same rate per age group or gender and health status.
But a state could get a waiver from the government for health status if it sets up a high-risk pool, in which states subsidize coverage for the sickest people who insurers won't cover. Before leaving town two weeks ago, Republicans made a last-minute change to the healthcare legislation that would create high-risk pools and give $15 billion for states to help fund them.
States also could use leftover funds from a $115 billion state stability fund intended to prop up the individual market, which is for people who don't get insurance through work and includes Obamacare's exchanges.
The amendment also would require insurers to contribute to the high-risk pools.
To opt out of the mandate, states have to get a waiver in which they attest that "the purpose of the waiver is to reduce premiums, increase the number of persons with healthcare coverage or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing conditions," according to the amendment first reported by Politico.
But the new amendment doesn't detail what exactly states need to do to attest to that.
It says that Health and Human Services Secretary Tom Price has 90 days to decide on the state's application for a waiver.
Price's role in the waiver could be pivotal as some conservatives have pointed out that a Democratic administration in the future could restrict the waivers if the Department of Health and Human Services is given too much latitude.
Rep. Tom MacArthur, R-N.J., a co-chairman of the centrist Tuesday Group, wrote the amendment after weeks of talks among centrists, conservatives in the House Freedom Caucus and GOP leadership and the White House.
It is not clear, though, if more members of the Tuesday Group will get on board.
Several members have been battered at rowdy town halls during the two-week Easter recess over protections for pre-existing conditions.
And leading centrists were silent on the deal Thursday.
In addition, a senior Republican aide told the Washington Examiner that it is too soon to say if the deal would push the legislation past the finish line.
"The question is whether it can get 216 votes in the House and the answer isn't clear at this time," the aide said. "There is no legislative text and therefore no agreement to do a whip count on."
Republican leaders have planned an all-member call for Saturday before Congress returns for a crucial two-week stretch, where healthcare and government funding — which runs out April 28 — are expected to be at the forefront of discussions.