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Republicans are trying to save their health plan with more money to cover sick people

It won’t help much.

Photo by Aaron P. Bernstein/Stringer/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

House Republicans are tweaking their health care bill Thursday before they head home for an extended break — a small funding boost to lower the cost of insurance for sick people. But the major issue that has stymied the bill so far remains unresolved.

The American Health Care Act has been in limbo since House leaders pulled it from the floor two weeks ago. Now, on Thursday, the House Rules Committee is expected to meet and vote on an amendment offered by two members of the House Freedom Caucus, the group of arch-conservatives whose opposition to the American Health Care Act helped stop it the first time around.

This amendment does not appear to get the bill the votes it needs to pass the House. No final vote is expected before lawmakers leave town. What it does accomplish is the appearance of movement, which is what the Trump White House wants.

GOP puts a little more money toward helping sick people afford insurance

The amendment would set aside some more money to help lower premiums for sicker people, providing $15 billion for states to reimburse health insurers for covering those patients, who often are more costly.

That is a relatively small addition to the $100 billion “stability fund” that the AHCA originally included for states to remake their insurance markets. That fund was already intended to let states do things — like provide additional financial assistance to people with high medical costs or help lower their out-of-pocket spending — to address the cost of insurance.

The $15 billion would be spread across states and over almost a decade, from 2018 to 2026. So, in the grand scheme, it isn’t a lot of money — and the problem that previously programs designed to help offset the cost of insuring sick people have run into is they don’t have adequate funding.

“I think the technical term for $15 billion over nine years for a high-risk pool is ‘chump change,’” Larry Levitt, senior vice president at the Kaiser Family Foundation, told me. ‘It’s nowhere near enough money to cover a meaningful share of the claims for high-cost patients.”

The amendment also doesn’t specify who qualifies as a high-cost individual. Instead, it requires the Department of Health and Human Services to work with consumers, health insurers and states to decide who should be eligible.

While more money to help people afford their health insurance might ultimately be necessary for AHCA to pass, it was the disagreement over Obamacare’s insurance protections that started a new round of finger-pointing this week and seemed to stop the AHCA in its tracks yet again.

What this actually accomplishes: The appearance of progress

This amendment does not appear to get the bill the votes it needs to pass the House. No final vote is expected before lawmakers leave town.

The bill has stalled because the far right and centrist wings of the Republican caucus disagree on a fundamental question: What to do about Obamacare’s insurance reforms, which prevent insurance companies from charging sick people higher premiums and require insurers to cover “essential health benefits.”

The amendment being considered Thursday doesn’t resolve that central issue.

This latest movement appears to be directed by the Trump administration. Speaker Paul Ryan and other House leaders met with top White House officials on Wednesday evening, where the plan was hatched. From the Washington Post:

“According to a senior White House official not authorized to speak publicly, Pence conveyed in the intense discussion that the president wanted the House to move immediately on health care in order to keep the effort of repealing the 2010 Affordable Care Act alive. Trump needs to score a short-term win on the issue, the vice president emphasized, since otherwise lawmakers may retreat on the issue.”

Here’s the problem: The Freedom Caucus wants to gut as much of Obamacare’s reforms as they can. The most recent reported plan would have allowed states to opt out of those provisions. But moderates, already squeamish about the estimated 24 million increase in the uninsured under the GOP bill, balked. They say they have campaigned on keeping on those protections.

For their part, House leadership is just portraying the latest movement as “progress” — and making no indications that a final deal, with the votes to pass, is imminent.

“This is a positive step that strengthens our plan,” McCarthy said in a note to the Republican caucus. “However more work remains.”

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