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In the span of two days, President Trump has given two interviews about a health care bill that does not seem to exist.
"I want it to be good for sick people," he told Bloomberg. "It is not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare."
I don't know what bill he's talking about, but it is certainly not the current Republican health care bill. As I wrote yesterday, the Republicans just revised the American Health Care Act last week to weaken protections for those with preexisting conditions. In order to win Freedom Caucus support, they added a provision that would give states a waiver from the requirement that sick people be charged the same premiums as healthy people.
This isn't the first time Trump has done this recently. On Sunday, he said this to CBS's John Dickerson:
Preexisting conditions are in the bill. And I just watched another network than yours, and they were saying, "Preexisting is not covered." Preexisting conditions are in the bill. And I mandate it. I said, "Has to be."
This just isn't true. The American Health Care Act that the Freedom Caucus supports — the one that has a shot of passing — doesn't contain the protections that Trump describes.
So what's going on here? Trump could be doing a few things. He might be lying about the American Health Care Act, or he may not understand what is in it. Some have interpreted these remarks as a demand that the Republican Party go back to the drawing board and write a bill that matches Trump's description.
I don't agree with this interpretation. There is no indication that the White House wants Congress to rework its health care bill. There is every indication that the White House wants Congress to vote on a health care bill, and that it remains unconcerned with the actual policy details of that bill. This suggests to me that Trump isn't making a new demand to Congress. He's inaccurately describing the Republican health care bill — but it's unclear whether he realizes what he's doing.
Three reasons I'm skeptical we'll see a health care vote this week
The White House kicked off the week bullish on health care. Sunday afternoon, sources there told Politico they expected the long-awaited House vote to finally happen this week.
White House is expecting a health care vote this week. "By Wednesday," a senior administration official says.— Josh Dawsey (@jdawsey1) April 30, 2017
This seemed unlikely but at least plausible. Momentum seemed to be building behind the AHCA. Most notably, the Freedom Caucus had endorsed the bill after winning key concessions with a new amendment that would further dismantle key Obamacare programs. So it seemed at least possible that when top White House officials told Bloomberg that they had the votes, they just might.
But now, just 24 hours later, the White House has backed off its initial claims.
Spicer NOT repeating the White House's earlier optimism on health care vote. "We’re not there yet."— Kyle Cheney (@kyledcheney) May 1, 2017
Thus begins another week in the will-they-or-won't-they Republican health care drama, where the White House demands progress on Obamacare repeal and Congress fails to deliver. This is a pattern that health care observers in Washington have become accustomed to in 2017.
Will this time be different? Will the House get the votes together for AHCA? I don't think so.
If I had to place a bet today, it would be that we do not see a vote on the Republican health care bill. I don't think they will be able to rally enough support to pass it. Here's why:
- We're starting to see moderate AHCA supporters flip against the bill. The changes made last week were meant to woo the most conservative House members. They further dismantle Obamacare by letting states waive out of the law's ban on preexisting conditions and its essential health benefits package. That won over the Freedom Caucus — but we're starting to see it alienate more moderate Republicans. There are at least two legislators — Reps. Mike Coffman from Colorado and Billy Long from Missouri — who previously supported AHCA but have come out in opposition since those changes were made.
- Big health care groups are coming out in opposition to the AHCA. The American Cancer Society, American Diabetes Association, American Lung Association, and other major advocacy groups released a statement Monday morning blasting the Republican bill and the new changes. This is after major health industry groups that represent hospitals and insurers also came out in opposition. There is not currently a single major health care group supporting AHCA. That doesn't bode well for its passage.
Do Republicans really want to force members to take a hard vote? There is a story I hear a lot lately of what exactly House leadership wants to happen on health care. They want to move the AHCA through the House, and don't really care what happens in the Senate. So what if it doesn't pass? Legislators will be able to say they did their part. This sounds, to me, like a terrible plan! House leadership is going to ask members to take a tough vote — one that will lead to countless attack ads about 24 million Americans losing coverage — on a bill that won't even pass? That has got to be a hard sell to rank-and-file members, especially those living in more competitive House districts.
Chart of the Day
Tennessee currently has no insurers signed up to sell coverage in the Knoxville area for 2018. The Obama administration worked aggressively to recruit insurers into "empty shelf" areas like this one. But we don't know what the Trump administration will do. Read my story about the uncertainty in eastern Tennessee here.
Your daily top health care reads, with research help from Caitlin Davis
Today's top news
- "Spending bill promises nothing to insurers, funds healthcare initiatives to fight opioid abuse": “The spending bill hammered out by lawmakers Sunday night is considered a win for Democrats, and gives $50 million to fight opioid abuse, but is flat for insurers looking for stability in the Affordable Care Act market. As expected, the bill includes no guarantee of Congressional funding for cost-sharing reduction payments to insurers.” —Susan Morse, Healthcare Finance
- "Trump to name anti-abortion advocate to lead federal family planning programs": “President Trump has picked an anti-abortion advocate to lead federal family planning programs. Teresa Manning, who has worked for the Family Research Council, will serve as the deputy assistant secretary for population affairs at the Department of Health and Human Services, The Hill confirmed Monday.” —Jessie Hellmann, the Hill
- "Florida Deal Would Reverse Key Part of Obama’s Medicaid Expansion": “Under a deal with Florida, the federal government has tentatively agreed to provide additional money for the state’s “low-income pool,” in a reversal of the previous administration’s policy. The Obama administration balked at providing more money to help hospitals cope with the costs of 'uncompensated care' for people who could be covered by Medicaid. If Florida expanded Medicaid eligibility, the Obama administration said, fewer people would be uninsured, and hospitals would have less uncompensated care.” —Robert Pear, New York Times
Longer reads and analysis
- "Does the president know what’s in the Republican health-care bill? And does it matter?": “We're now so used to Trumpisms, such as 'people like it a lot,' that we hardly notice that Trump seems lost on the details of the bill itself. In fact, every piece of evidence suggests that he has blown off those details — which could change dramatically if the House passes a bill for the Senate to play with — and is more interested in being able to fulfill a general campaign promise than in the specifics of the legislation.” —David Weigel, Washington Post
"Exodus By Puerto Rican Medical Students Deepens Island’s Doctor Drain": “In the Residency Match announced in March — where students learn where they will continue training — about half of students matched to the mainland, based on figures provided by officials at Puerto Rico’s four medical schools. That exodus is particularly alarming because the commonwealth’s health care infrastructure is suffering from a shortage of trained physicians.” —Carmen Heredia Rodriguez, Kaiser Health News