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An Obamacare adviser walks into the Trump White House...

White House

Multiple sources tell me that former Obama adviser Zeke Emanuel was at the White House Thursday, meeting with staff about what comes next on health care. I'm told the meeting included a discussion of funding for reinsurance — one of the programs that protects insurers against exceptionally large financial losses if they have a handful of really high-cost medical claims to pay out. This is not the first meeting Emanuel has taken at the White House; he met with Trump about 10 days ago too.

A White House spokesperson confirmed the meeting.

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The Freedom Caucus has a new wish list, and it's pretty revealing

The Freedom Caucus laid their cards on the table in a meeting Thursday with the Washington Examiner's editorial board. The group of conservative House members have narrowed their demands to two items:

  1. Ending Obamacare's essential health benefits requirement, which stipulates that health insurers must cover 10 specific categories of medical care. This includes things like mental health services and maternity coverage.
  2. Ending the Obamacare requirement that insurers charge sick and healthy people the same prices. This is called "community coverage," and the Freedom Caucus would like to get rid of it, instead letting insurers charge higher premiums to sicker patients whom they expect to cost more.

This wish list may look small, but it's not. It's huge! These changes would essentially make the health insurance market of 2018 look like the pre-Obamacare marketplace of 2013. The requirement that insurers offer coverage to all patients would still exist, but it would be meaningless, as insurers would be allowed to charge sick patients unaffordable prices. In other words: The availability of insurance doesn't matter much when the premium is $5,000.

You can read a full explainer from me on what these changes mean. But there are two key takeaways from the Freedom Caucus's current position on Obamacare repeal and replace:

Republicans are incredibly far from any deal on health care. These demands from the Freedom Caucus do not show a party coming together on health policy. They show a party staunchly divided. The last GOP health bill would have caused 24 million people to lose insurance, and moderate Republicans opposed it on those grounds.

Making these changes would almost certainly kick even more Americans off their coverage. The Freedom Caucus's agenda is not something that moderate Republicans, like those in the House's Tuesday Group, would get ever get behind. The same old divide between those who want to repeal Obamacare and those who feel compelled to replace it still exists.

Conservative Republicans' main target isn't Medicaid. It's insurance regulation. Freedom Caucus Chair Mark Meadows (R-NC) told the Examiner something that felt worth pausing on:

"We're willing to give the moderates something they want, whether it's on Medicaid expansion or additional monies for perhaps something they say that was being pulled out," Meadows said. "But in the end, the request is pretty simple: two of 12 Obamacare mandates."

It's interesting that the Freedom Caucus's main target is not Medicaid, the entitlement program for low-income people that has grown to cover 74 million Americans under the Affordable Care Act. Granted, the current GOP health care bill makes deep cuts to that program.

But when the Freedom Caucus chose a target for further cuts, it was Obamacare's private market reforms. Republican governors who expanded Medicaid became a potent political force lobbying in the program's favor. It's possible the Freedom Caucus made a political calculation of their own: They can't stop a decades-old entitlement program like Medicaid from existing, but they might have a better shot attacking Obamacare's individual market reforms, which are only three years old and cover far fewer people.

Happy Friday, here is a children's book about health policy

Former Obama health care adviser Bob Kocher has taken it upon himself to explain why, exactly, health care policy is so hard — in a riff on the classic children's picture book If You Give a Mouse a Cookie.

Yes, it's a bit silly, but it's also a great explainer on how all the different policies in the Affordable Care Act are intertwined — and how making one change (trying to increase coverage, for example) can lead to a whole host of other changes.

You can read it all here. Kocher is, surprisingly, not the first former Obama adviser to work on an illustrated book about health policy. That honor goes to MIT professor Jonathan Gruber, who wrote an entire comic book about the Affordable Care Act.

Stat of the Day

A new poll finds that Republican support for repeal has fallen significantly over the past month. Read more.

Kliff's Notes

With research help from Caitlin Davis:

  • "Pence Breaks Ties on Measure Targeting Abortion Providers": “Vice President Mike Pence cast a rare tie-breaking vote for the second time on Thursday to pass a resolution overturning an Obama administration rule that prevents states from discriminating against family planning providers for political purposes. The resolution, which would scrap a regulation blocking states from withholding Title X family planning grants to Planned Parenthood and other providers that offer abortion services, is part of a Republican effort to use the Congressional Review Act to overturn a number of Obama-era rules.” —Jon Reid, Morning Consult
  • "Freedom Caucus member: Passing healthcare bill would cost GOP majority": “Rep. Louie Gohmert’s (R-Texas) speech came after President Trump took to Twitter earlier in the day to attack members of the Freedom Caucus, saying Republicans ‘must fight them, & Dems, in 2018!’ Gohmert said the GOP bill scuttled last week that was aimed at repealing and replacing ObamaCare wouldn’t have really kept the party’s seven-year promise for a better healthcare alternative. ‘So, I’m sorry. This bill is going to ultimately result in Republicans losing the majority,’ Gohmert said.” —Cristina Marcos, the Hill
  • "Ryan Suggests CSR Decision Lies with Trump Administration": “At issue in the lawsuit is whether the Obama administration illegally funded cost-sharing reduction payments, which help the ACA’s lower-income enrollees afford out-of-pocket costs. The House sued the administration for making the payments without a specific appropriation. Last year, a federal judge sided with the House. Though the Obama administration appealed the decision, the Trump administration took over the case after the transition period.” —Mary Ellen McIntire, Morning Consult