Will the most conservative members of Congress accept that the politics of health care have changed?.. Will they acknowledge that any reform must include continued protections for pre-existing medical conditions?.. two camps of defectors from the Senate’s reform bill. One consists of Republican moderates— Rob Portman, Dean Heller, Susan Collins, Lisa Murkowski —who claim the bill is too mean to poor and sick people... With the stakes this high, the Senate leadership will gladly shuffle some money toward opioid treatment, rural health-care providers or Medicaid. So getting the “moderates” on board is simple and transactional. They name a price, they get pork, they vote yes... Sens. Ron Johnson, Mike Lee, Rand Paul and Ted Cruz have been clear from the start that any bill must lower premiums, which involves getting rid of costly ObamaCare mandates. And there is no question that among the most expensive mandates are those designed to protect individuals with pre-existing conditions—in particular “community rating,” which requires insurers to charge the same prices regardless of health status.
The House Freedom Caucus was so intent on getting rid of community rating that it nearly derailed the bill. Only after the conference added an amendment allowing states to apply for waivers from community rating did the most conservative members finally came on board...Freedom Caucus members tend to hail from inordinately conservative (and safe) congressional districts, whereas senators represent entire statewide populations. And a sizable majority of the public strongly supports retaining protections for pre-existing conditions...every American remembers two particular provisions of the law—pre-existing conditions and coverage for children up to 26. These policies are simple and sound good. And they have become over the years a new standard in most people’s minds...Conservatives will argue their side just needs to do a better job explaining how these mandates drive up costs for everyone, or lower the quality of care...conservatives face a choice. They can work with their colleagues to minimize the costs of the mandates (there are innovative ways to do this) and build in different free-market reforms to lower premiums.
The problem comes because the bill would then still leave in place not only the requirement that insurers cover those with pre-existing conditions, but also the restriction against charging more based on health status, a regulation known as community rating.In such a market, healthy people would have every incentive to purchase the cheapest plans possible, knowing that they could always upgrade to more comprehensive plans if they get sicker.. “In a community-rated environment, giving more choice to healthy individuals means worse coverage for those who are sicker,” said Michael Cannon, an Obamacare opponent from the libertarian Cato Institute, who is sympathetic to the House Freedom Caucus position on regulations.“This proposal shows bad faith,” he said. “The President is being misled by incompetent advisors who will cause the GOP to lose both chambers of Congress if this bill passes.”