Zombie Trumpcare is undead, and that won't end well for Republicans
The alleged terms of the bill's revival do not make a great deal of political sense.
Matt Fuller, who covers the Freedom Caucus for The Huffington Post, reports Freedom Caucus head Rep. Mark Meadows said he believes the deal would allow states to waive the Essential Health Benefits rules under Obamacare - those are the rules that say health plans have to cover certain benefits like maternity care, prescription drugs and hospitalization - and, in a change from the last version of the AHCA, would allow them to waive a rule called "community rating."
Community rating is the rule that says insurers have to charge customers the same price, except that they may impose limited surcharges based on your age and whether you smoke. An insurer is not allowed to charge you more just because you are sick.
The Freedom Caucus wants to give insurers much more freedom to charge different customers different prices, and they have some not-crazy reasons why. In particular, as I wrote a couple of weeks ago, if you eliminate the Essential Health Benefits rules and keep other Obamacare regulations, it might become impossible to sell certain kinds of insurance coverage to anyone.
People who want coverage for expensive benefits, such as substance-abuse treatment, might wait until they need the coverage to buy it. Insurers, unable to block specific customers, would have to price insurance on the assumption that any buyer is buying a specific benefit because they intend to use it. Ultimately, the pricing for many benefits would become so unattractive that insurers would stop selling coverage for them altogether.
Obamacare prevents this problem by making everyone buy approximately the same basket of coverage. Under the amorphous new deal being discussed, this problem would be addressed through insurers' new freedom to price products however they wish for different customers.
Insurers still couldn't tell a person with cancer that he or she can't get chemotherapy coverage, but they could tell him that coverage would cost $10 million a year, which is kind of like telling him he can't have the coverage at all. This pricing flexibility would keep the sickest patients out of the insurance pool and thereby make it economical to sell coverage for chemotherapy at a reasonable price to customers who do not have cancer.
You can see the political problem, right?
It's part of a broader problem on healthcare for Republicans: While they got a lot of political buy-in for the idea that Obamacare "should be repealed and replaced," there was not buy-in from the electorate for Republicans' preferred terms for the replacement, such as that cost-shifting from the healthy to the sick should be greatly reduced.
Of course, a reduction in cost-shifting might even sound good at first pass. ("Why should I pay for somebody else's health care?") But when the specific effects become clear - the matter of greatly jacking up insurance rates for expectant mothers and cancer patients so young, healthy men can pay less - the politics become toxic.
If and when a revised AHCA becomes available containing this provision, it will likely hit the same political wall that the last AHCA did: The proposal will be very unpopular, with a loud and angry constituency opposing it, and no significant political constituency eager for it, except for rich people who want the tax cut embedded within the AHCA.