Republicans left Washington on Friday without a health-care deal, despite renewed negotiations after last month’s fiasco and a burst of White House diplomacy. Perhaps the two-week recess will be a cooling-off period and we hope the House’s factions can agree on a deal. If they can’t, then at least we’ll learn who’s responsible for defeat.
After the Freedom Caucus killed the original health bill in March, the talks resumed, not least for practical and political imperatives. President Trump and Republicans campaigned on repeal and replace, and the President at least wants to keep his word. The ObamaCare exchanges are also fragile and precarious, and consumers harmed by rising premiums and declining choices are likely to blame the party in power.
But the divide between conservatives and centrists hasn’t narrowed. Last week, in part to create the appearance of progress, the House added an amendment on “invisible risk sharing” that would help bring down premiums by absorbing high-cost patients. The compromise was worked out by the Freedom Caucus’s David Schweikert of Arizona and Tom MacArthur of New Jersey, who is more moderate.
These talks are constructive, though the larger question is whether most of the Freedom Caucus members want a bill they can back or are merely trying to shift the blame for failure. They say they’ll support a bill that repeals, or creates a state waiver to avoid, the ObamaCare mandates that prohibit insurers from denying coverage or charging more to patients based on pre-existing conditions. The Freedom Caucus is right that these mandates drive up the cost of insurance, but the moderates understandably don’t want to have a debate about how much to soak the sickest patients.
One reason is that this fight is largely pointless. True, the House bill doesn’t repeal the “community rating” that limits how much premiums can vary among consumers, but it does relax it enough to be effective repeal. Under ObamaCare, the costliest plan can be no more than three times as expensive as the cheapest, known as a 3 to 1 rating band. The House bill moves to a 5 to 1 band, which is above the true cost of care.