The House of Representatives is once again attempting another effort to repeal the ACA. The effort is a result of the White House push to try and get a vote before the President had reached the informal judgement date of 100 days in office.

The vote could still take place this week if Speaker Paul Ryan is sure he has enough Republican votes.  They can afford to lose approximately 20 votes (depending on how many members are present and voting). The vote on the America Health Care Act (AHCA) would now include a package of amendments to the last bill.

The modifications were negotiated by House Freedom Caucus Chairman Mark Meadows (R-NC) and Tuesday Group Co-Chair Tom MacArthur (R-NJ) who took it upon themselves to unofficially represent members of the Freedom Caucus and the less conservative Tuesday Group. Both Republican caucuses are loosely formed without a formal membership and in fact their exact numbers have not been detailed.  It is also clear that the negotiations did not result in unanimity by either group although the Freedom Caucus did endorse the latest product.

An eight-page amendment to the AHCA, allows states to opt out of ACA requirements on essential health benefits, community rating requirements and how much older Americans are charged for coverage.  To receive a waiver of the law through HHS states would indicate that their efforts would: reduce average premiums for coverage; increase enrollment; stabilize the market; stabilize premiums for individuals with pre-existing conditions; or increase the choice of health plans.  Based on the waiver, states also would have to set up a high-risk pool, presumably to push back on criticisms that the Majority-party plan would harm the sickest patients.

The threat to coverage and patient protection is that the waivers could accomplish some goals such as expanded markets and lower premiums by reducing requirements and standards on insurers and policy coverage and in the end leave a patient more vulnerable.

States could opt out of the essential benefits package that include maternity coverage, emergency room services, mental health and substance use coverage.  It also allows states to opt out of the community rating protections which limit insurance policies from charging patients with certain health and pre-existing condition more for their coverage.

Beyond the waivers for states the legislation still includes the same repeal parts and it still cuts Medicaid by nearly $900 billion.  CBO has not reviewed the bill for an updated budget score or analysis of what it would do to the 24 million that would lose coverage under the original bill.  They also do not expect to have a new budget score this week.

CWLA continues to oppose the bill even with the changes and by week’s end it was clear that the Republicans had not yet flipped enough votes despite the endorsement of the Freedom Caucus.  It was reported that outside conservative groups had been applying pressure to get a bill passed.  It is also believed that certain members, including Congressman Rodney Frelinghuysen (R-NJ), was feeling the heat as the Chair of the House Appropriations Committee.  His earlier opposition as a Republican chairman was viewed as a signal to other Republicans that they could oppose the measure in the last attempted vote.  He has been publicly listed by news organizations as “leaning yes”.

The House will be out for a week after Friday so they have five more days to get it done before the next budget debate starts.