Paul RyanJ. Scott Applewhite/AP
Republicans are closing in on a deal to push their plan to repeal and replace Obamacare through the House.
The compromise, first reported by Matt Fuller and Jonathan Cohn at the Huffington Post, would allow states to obtain a waiver from the federal government to do away with certain protections from the Affordable Care Act, better known as Obamacare.
According to the Huffington Post, the deal would initially keep two provisions — essential health benefits and community rating — favored by moderate GOP lawmakers but allow states to waive these protections. In order to waive the protections, states would have to fulfill two provisions: prove that the waiver would bring down costs and either join a federal high-risk pool or establish their own.
The full text of the proposed amendment, obtained by Politico’s Jake Sherman and Anna Palmer, states that the waiver would be granted by the federal government if the state can prove that they have an alternative to “reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state.”
Essential health benefits require insurers to cover a baseline of health procedures such as prenatal care and emergency room visits. Community rating means that insurers must charge people living in the same area the same price for insurance regardless of things such as age, gender, or pre-existing conditions.
“The gist of this is that federal protections for pre-existing conditions and required benefits remain…unless a state doesn’t want them to,” tweeted Larry Levitt, senior vice president at health policy think thank The Kaiser Family Foundation on Thursday.
Without the community rating, insurers could charge people with pre-existing conditions higher premiums and some policy experts fear this could price sick people out of the market.
However, this means that the Trump administration, most likely Secretary of Health and Human Services Tom Price, would have final say on whether or not a waiver is granted.
While the deal was reportedly reached by conservative House Freedom Caucus chair Rep. Mark Meadows and moderate Tuesday Group chair Rep. Tom MacArthur, it also bears similarities to a previous deal that drew the ire of moderates for going too far in pulling back protections.
Additionally, it does not address the concerns of moderates such as the defunding of Medicaid expansion or the estimates that the Affordable Health Care Act could leave up to 24 million fewer people without health coverage over the next 10 years.
The amendment comes the day after reports that the White House was pushing for a deal to be completed by the end of next week in order to show progress during Trump’s first 100 days as president. Additionally, House Speaker Paul Ryan said in London on Wednesday that the GOP was putting the “finishing touches” on an Obamacare deal.
Passing the AHCA, even with the proposed changes, would be difficult in the short-term as Congress must also pass a bill to fund the federal government before parts of it shut down on April 28.