If moderate Republicans flip on the health bill, they will regret it
But this new proposal is ugly for moderates, both substantively and politically, and they are likely to pay a political price if they support it.
There is nothing in this revision for those Republicans who opposed the AHCA. It would throw too many people off health insurance, disrupt healthcare markets too much, and expose people to too much risk if they get sick. In fact, this bill would be worse on the dimensions those members worried about before.
The latest proposal would allow states to waive out of Obamacare rules that require health insurance to cover core benefits like prescription drugs and hospitalization, and out of rules that prohibit insurers from charging you more if you have a preexisting condition.
That is, under this plan, insurers could sell plans that don't cover pregnancy, or don't even cover doctor's visits. It would ensure that everyone has "access to coverage" only in the sense that insurers would have to offer to sell a plan to anyone. They could set the premium at $10 million for people with preexisting conditions, and that offer of insurance at $10 million would constitute "access to coverage."
Last month, many members on the moderate end of the Republican House conference made on-the-record statements about why they opposed the AHCA that would seem to box them into opposing this version, too.
Rep. Ileana Ros Lehtinen of Florida said "too many of my constituents will lose insurance and there will be less funds to help the poor and elderly with their healthcare" if the AHCA were passed. This amendment does nothing to address those concerns.
Rep. Rodney Frelinghuysen of New Jersey objected because of the bill's "denial of essential health benefits in the individual market," as well as its cuts to Medicaid. Those issues remain substantially the same in the new bill.
Rep. Barbara Comstock of Virginia said she opposed the bill because of "uncertainties" it would create, but she said at least it required insurance to cover preexisting conditions - a proviso that would no longer hold with the new version.
And Rep. David Young of Iowa said he doesn't "think people should be discriminated on" preexisting conditions. This bill would allow insurers to do so.
If they vote for this new version, these members and many others will be subject to attack based on their own past statements - that they said the healthcare bill was unacceptable, and then they voted for it after it was made even more unacceptable.
That's not to say they can't change their minds. But I wouldn't assume they will.
Many of these "moderate" defections were unexpected the first time around, and came from members who aren't even that moderate - including Frelinghuysen, who chairs the House Appropriations Committee and is close to leadership.
Frelinghuysen represents an affluent, highly educated suburban district, centered on Morris County, New Jersey, which has been Republican approximately forever but has trended toward Democrats in recent years. His choice to oppose the prior iteration of the AHCA was a signal that he, like many members, viewed a vote for the bill as a threat to his political survival.
There's little reason to expect this new version, which adds the evisceration of protections for people with preexisting conditions, would be less of a threat.
They should be afraid. The story will be that the bill was changed to placate extremists who want to hang sick people out to dry, and that these members went along with it.