One of the conservative sticking points in judging the House GOP’s health plan has been the measure’s treatment of “non-budget”-related items. Under the legislative mechanism Republicans are using to move the American Health Care Act, the bill’s particulars must have an impact on spending and revenues. This makes it uncertain if something like Obamcare’s provisions for pre-existing conditions—which are mandates on insurance companies, but also affect the price of health coverage—would pass muster under the “reconciliation” process. Reconciliation is relevant because filibusters do not apply; it would allow Republicans to undo portions of Obamacare with just 51 votes in the Senate, instead of 60.
GOP leadership has actually bragged that its legislation retains the Affordable Care Act’s pre-existing conditions regulations. Under Obamacare, “guaranteed issue” forces insurers to offer consumers coverage regardless of a preexisting condition. To keep insurance affordable to such individuals, the law also includes a “community rating” restriction, which prohibits insurers from charging people of varying risk but similar age different premiums. Some on the right are concerned that this tandem creates a market distortion, giving young or low-risk individuals an incentive to forgo insurance and wait to purchase it until they need it. Doing so leaves a larger proportion of higher-risk—and thus, more expensive—consumers in the market, driving up costs. A policy like Obamcare’s individual mandate was designed partly to mitigate such price risk, compelling those who would rather skip insurance to buy it. But the AHCA effectively eliminates the individual mandate, and keeps the insurance regulations in place.
Amid internal party debate about the bill, Sen. Ted Cruz is the first Republican lawmaker in the upper chamber to call for repeal of the insurance mandates, and to do so through reconciliation. He writes with Rep. Mark Meadows, chairman of the House Freedom Caucus, in the Wall Street Journal:
The Cato Institute’s Michael Cannon, a longtime Obamacare critic and detractor of the AHCA, recently provided a similar take to THE WEEKLY STANDARD, characterizing the insurance mandates “conditions on federal spending.”
Despite Cruz’s wishes, however, the senator would still run into another procedural roadblock. Should the AHCA pass the House, Senate Majority Leader Mitch McConnell plans to bring it directly to the floor for an amendment “vote-a-rama.” Amendments to the bill would be subject to a 60-vote threshold—an insurmountable obstacle, given Democratic resistance. If the GOP wanted to undo the insurance mandates, the legislation’s authors would have written it into the original language, or the matter would have been settled in the House.
Speaker Paul Ryan said Wednesday that the bill can now undergo “some necessary improvements and refinements,” subsequent to the release of estimates from the Congressional Budget Office that have jolted Republicans off-course. He did not go into details. The AHCA goes to the budget committee for a vote on Thursday, but any substantive changes would have to be cleared next by the rules committee, prior to the legislation’s presentation on the House floor.
More from Cruz and Meadows in the Journal here.
