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Schrödinger's AHCA

The GOP health bill seems simultaneously alive and dead.

Photo by Chip Somodevilla/Getty Images

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Can a bill be simultaneously dead and alive? Because that's how the American Health Care Act is looking right now.

A week and a half after House Republicans dramatically canceled their vote on the AHCA, it's now clear that the White House isn't yet ready to accept defeat and walk away.

President Trump insisted on Twitter this weekend that "talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue." Any claims that the effort was dead, he continued, were from "Fake News media" who don't "know the love and strength in R Party!"

To back up those words, Trump has sent administration officials like Vice President Mike Pence and Chief of Staff Reince Priebus to Capitol Hill, where they're floating potential changes to the bill that they hope could win over holdout members of the Freedom Caucus.

Some Freedom Caucus members, too, have sounded more amenable to compromise — perhaps because it's becoming more and more clear Obamacare really will stay in place if they don't deal. The group's chair, Rep. Mark Meadows (R-NC), said Monday night that he's spent the past three days trying to look at the bill from a "more moderate member's perspective," per the Washington Post's Mike DeBonis.

A close White House ally, Rep. Chris Collins (R-NY), even told reporters that the administration wanted a House vote on a revised health bill this week, before Congress leaves for recess. More meetings are scheduled to take place tonight. So all of this is a definite change of tune from a week and a half ago, when Trump's team was saying the president was ready to move on to other things.

And yet...

House Republican leaders seem much less optimistic about a vote happening anytime soon: Speaker Paul Ryan said this morning that discussions were still in "conceptual stages," and House Ways and Means Committee Chair Kevin Brady said it was "premature" to talk about a schedule for reintroducing a bill. So soon after being burned on this, GOP leadership isn't ready to raise expectations again.

More importantly, the central problem of winning over both the Freedom Caucus and the Coverage Caucus remains. Though GOP leaders found it convenient to blame AHCA's failure mainly on holdout conservatives, the reality is that moderates and mainstream Republicans worried that the bill would cause millions to lose coverage were also defecting in droves. And in many ways, the demands of the Freedom Caucus and Coverage Caucus seemed diametrically opposed — any changes made to win over members of one group swelled the opposition of the other.

That's playing out yet again as the White House and the Freedom Caucus discuss letting states apply for waivers from Obamacare's "community rating" requirement, a change that could let insurers in at least some states charge people higher premiums if they are sick or have preexisting conditions — something that seems likely to repel Coverage Caucusers already reluctant to back the AHCA.

A side note: Amazingly enough, Republicans just recently touted the fact that the AHCA didn't do this as a selling point for the bill. As Bloomberg's Steven Dennis pointed out, the House GOP website promoting the AHCA flatly stated that "Americans should never be denied coverage or charged more because of a pre-existing condition."

The bigger picture is that bringing both the Freedom and Coverage caucuses together will require some seriously creative legislating — or a total cave from at least one group.

Chart of the Day

Robert Wood Johnson Foundation

Hospitals' uncompensated care costs have plummeted in Medicaid expansion states. An Urban Institute report finds that while all types of hospitals in these states saw costs fall and Medicaid revenue increase, "the Medicaid expansion’s effects on margins were strongest for small hospitals, for-profit and non-federal government-operated hospitals, and hospitals located in non-metro areas."

Kliff's Notes

With research help from Caitlin Davis

  • "The GOP’s new Obamacare repeal push is in flux. Here’s what we know": "There is a lot of space between policy discussions and legislation. There were reports Monday that a proposal would come out that night, but it didn’t happen. Meadows told reporters he expected to see text of a proposal sometime today. It might show up. It might not! We still don’t know whether these current talks will turn into an actual legislative proposal or fizzle out over the same issues that split Republican legislators on the last health care bill." —Sarah Kliff, Vox
  • "Trump's new Obamacare repeal push faces tough slog in Congress"​: "A renewed bid by the White House to unite fractious Republicans around the bill — left for dead a week ago — briefly raised expectations that a deal was imminent. But by Tuesday afternoon, leaders of the polarized factions of the House GOP were no closer to agreement than they were when talks collapsed last month and delivered an embarrassing blow to Trump and Speaker Paul Ryan. White House officials privately said they don't expect a deal anytime soon on health care." —Kyle Cheney, Rachael Bade, and Josh Dawsey, Politico
  • "CBO provides a roadmap for improving AHCA": "CBO’s analysis of the AHCA is extremely concerning. Although one might dispute the specific numbers, the estimate demonstrates that AHCA as currently designed would lead to substantial loss of insurance coverage, particularly among lower-income families. Rather than criticizing the agency for delivering bad news, policymakers should examine the analysis to identify provisions that should be modified in order to produce a more sustainable reform — and to get a better assessment from CBO." —Joseph Antos and James Capretta, Health Affairs

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