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GOP Factions Inch Toward Compromise on PPACA Overhaul

Moderates and conservatives try to make a deal

During a question-and-answer session in London, House Speaker Paul Ryan (R-Wisconsin) announced that Republicans are busy putting together a second attempt at dismantling the Patient Protection and Affordable Care Act (PPACA), according to The Hill.

“We’re in the midst of negotiating sort of finishing touches, because our members want to make sure that we lower premiums,” Ryan said.

“Health care is not dead,” he added. “We’re still working on it.”

Talks on the health care measure have continued during Congress’ two-week recess. Representative Mark Meadows (R-North Carolina), chairman of the conservative House Freedom Caucus, and Representative Tom MacArthur (R-New Jersey), co-chairman of the centrist Tuesday Group, have spoken to Ryan’s office and to Vice President Mike Pence about the next steps in the overhaul process, according to The Hill.

MacArthur said he is proposing amendments to the GOP bill that he thinks could help bridge the gap between moderates and conservatives. Details of the plan have been posted on the Huffington Post website.

The deal brokered between Meadows and MacArthur reportedly would allow states to obtain waivers eliminating the so-called community rating provision―the rule that prohibits insurers from charging higher premiums to people with pre-existing conditions. In order to obtain the waiver, states would have to participate in a federal high-risk pool or establish their own, and satisfy some other conditions.

In exchange for that conservative concession, the amendment would reinstate the “essential health benefits” that were already taken out of the bill―although, again, states could waive those provisions if they were able to show that doing so would lower premiums, increase the number of people insured, or “advance another benefit to the public interest in the state.”

GOP leaders are expected to discuss the amendment during a conference call with party members scheduled for April 22. The odds are slim, however, that the new bargain will win everyone’s approval.

“Republicans are trying to say their amendment will cover people with pre-existing conditions―because, first, the legislation still claims those people can’t be denied coverage, and second, because there will be high-risk pools for those people if insurance costs dramatically go up for them,” the Huffington Post article states. “The reality, however, is that insurers would be able to effectively deny coverage by pricing sick people out of the market.”

Republicans need 216 votes to pass their health care bill, and based on statements from GOP members, even with the support of the entire Freedom Caucus, there may be enough moderate hold-outs to prevent passage of the amended bill.

Sources: The Hill; April 19, 2017; and Huffington Post; April 19, 2017.

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