The New GOP Health Care Bill Shows Republicans Have Given Up on Fully Repealing Obamacare

Moderates want to keep Obamacare's essential structure in place.



Republicans in Congress have given up on fully repealing Obamacare.

Instead, they have decided they want to leave pieces of it in place, along with a system of tweaks and opt-outs that require federal permission and may never be used. And even that may be too much for some GOP moderates.

Last month, House Republicans made a failed attempt to pass the American Health Care Act, a bill that would have partially repealed and replaced Obamacare, putting in place a new system of tax credits while leaving many of the health law's key insurance regulations in place. Since then, factions representing House conservatives and House moderates have continued to work on bill that they hoped might garner more support.

The vehicle they settled on to manage their differences was a system of state-based opt-outs, in which states could apply for permission from the federal government to escape some of the regulations put in place under Obamacare, and left in place by the AHCA, under certain conditions, after winning federal approval.

This limited and restricted system of opt-outs is at the core of a new amendment to the bill.

The amendment, which was reported last night by Politico, would allow states to apply to opt out of some of Obamacare's community rating provisions starting in 2018, to override the federally mandated essential health benefits rules and set their own starting in 2020, and to charge individuals based on health status, provided a high risk pool or some facsimile to cover the sickest patients.

But Obamacare's major insurance regulations would remain on the books at the federal level, as the default national option, which would mean that federal policymaking under either Republican or Democratic administrations would revolve around those rules.

Nor is it clear that the opt-outs would actually be used. The majority of states are currently governed by Republicans—yet as health policy analyst Chris Jacobs notes, not one has even hinted at interest in applying for a waiver. And although the new amendment appears for a speedier and more straightforward application process than states have seen in the past with other types of federal health policy waivers, it still leaves significant room for a future administration to deny states their requests, should they submit them.

The new amendment, in other words, calls for state flexibility that might turn out to be entirely symbolic.

But even that might be too much for Republican moderates. Although the new amendment looks like to increase support amongst the more conservative members of the House Freedom Caucus, their moderate GOP counterparts in the Tuesday Group may not be on board. And it's far from clear what it would it would actually take to bring them on board–even to the group's leadership.

In an interview with Philip Klein of The Washington Examiner yesterday, Tuesday Group leader Rep. Charlie Dent (R-Pennsylvania) said he was still not on board with the bill. Dent cited the AHCA's treatment of Obamacare's Medicaid expansion–which the new amendment does not address–as one reason for his opposition, and seemed to indicate that he opposed overturning Obamacare's preexisting conditions rules for insurance companies. What would Dent prefer instead? Klein asked, and here's how Dent responded:

Conservatives have cited the need to reduce premiums as a reason for supporting stripping out Obamacare regulations, such as mandated health benefits and limits on how much insurers can charge based on health status.

When asked how he would prefer to reduce premiums without removing Obamacare's regulations, Dent said, "That's the $64,000 question."

When pressed further on whether there were any ideas for reducing premiums that have been proposed that he would support, he said he didn't want to get into a negotiation with a reporter in an interview…

GOP moderates now appear to hold the votes to either send the AHCA on to the Senate or keep it stuck in the House. But if Dent is any indication—and there are signs he is—aside from simply leaving Obamacare in place and making slight tweaks to its structure, it's not at all clear what would satisfy them. And it's not clear that most GOP moderates really know either.

Update: The House Freedom Caucus has officially endorsed the AHCA with the new amendment.

Update 2: Heritage Action, an influential conservative activist group that key voted opposition to the initial draft of the AHCA, has backed off its position, with caveats. "To be clear," Heritage Action CEO Michael Needham said in a statement, "this is not full repeal and it is not what Republicans campaigned on or outlined in the Better Way agenda. The amendment does, however, represent important progress in what has been a disastrous process. Given the extreme divides in the Republican Party, allowing Texas and South Carolina to make different decisions on health insurance regulations than New York and New Jersey may be the only way forward."

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  1. Damn. My shocked face is completely worn out and unusable at this point.

    1. Republicans and knuckle-dragging Trumpkins haven’t yet figured out that Obama won, and some form of Obamacare is here to stay.

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  2. Well, sure. A little bit of slavery is better than none, at least if you’re on of the slaveowners and even more so if you’re one of the manager’s who gets paid to whip the slaves.

    1. Slaves. Ha ha ha.

  3. “Republicans in Congress have given up on fully repealing Obamacare.”

    Pssst. I’ve got a secret to tell you. They *never* planned on repealing it. I can’t find it in the archives, but I swear that that there was a Hit and Run post a few months after Obamacare passed which quoted a couple Republicans as saying it was too entrenched to repeal.

  4. If I was Congress, my plan for repealing and replacing Obamacare would be so simple it’s painful. Just pass a bill stating that the HHS secretary has full and sole discretion to figure the whole thing out. Profit!

    1. HOW to repeal it isn’t the problem. It’s not like they don’t know how to undue a bill from a purely logistical perspective. What is sorely lacking is the WILL to do so. Democrats won’t do it, so it must pass through reconciliation (limiting the amount that can be repealed). Moderate Republicans don’t want to get rid of it because they think it’d hurt them, badly, as the healthcare market looses whatever functionality is has left.

  5. Would any actual insurance company write a policy on a building while it is burning? Would they write a new homeowner policy after the hurricane – to cover current damage? How many insurance companies are going to be willing to write ANY policies if they are losing money on all or most of them? Can the politicians actually legislate the premiums and the terms without giving tax payer loot to those companies to compensate for reality? Is this all kabuki theater to obscure the fact that those politicians want to remove any hint of individual liberty, free market, and plunge us into the cesspool of total government control ( as opposed to the current 80 – 99%) of our medicine, our health care providers and the details of our intimate lives and choices? I’d say it’s a good bet.

  6. The New GOP Health Care Bill Shows Republicans Have Given Up on Fully Repealing Obamacare

    No balls. They’ll rightfully suffer in the midterms for this. That is all.

    1. It’s not that they have no balls, it’s that they don’t actually believe what they claim to believe.

  7. But they the GOP will cut taxes. Remember, Dick Cheney said that Reagan proved that deficits don’t matter.

    Just spend all you want to. Good thing the GOP has control of every government branch.

    1. Maybe you should spend some money on paying your goddamn bet.

      1. That never gets old. Really hilarious, no really.

  8. There are a few portions that the Republicans want to keep. I have a problem with keeping your kids on your insurance until they are 26. KIDS SHOULD GET OUT OF THEIR PARENTS BASEMENTS AND MOVE THE HELL OUT! Millineals are entitled little brats!

    1. I really really hope you aren’t a boomer. Boomers are old AF so it’s hard to call them brats, but they both invented and perfected the word “entitled.” Millennials are not the villain here, not even close.

  9. At this point, maybe it would be better to blow up the insurance market. Or let it blow up. If things get fucked up enough there will be more impetus to do a more radical repeal and rewrite. Republican moderates seem to want to save ObamaCare, rather than replace it with something else. Same shit as social security. Republicans are now the party of “saving” the welfare state, rather than getting rid of it.

    1. Good points. Wish they were made more often, but neither the R’s or the D’s will do that.

  10. IIRC, doesn’t the ACA have provisions in place that grant the Health and Human Services Director can issue waivers for companies and (maybe) individuals?

    If so, the President could make the law dead letter with the stroke of a pen, presuming that is what he wants,

    (Big presumption, I know. I am fairly certain that he is as surprised by his own policy positions as we are.)

    1. Exempt everyone except the federal legislature.
      That will “fix” it.

  11. As well they should keep it. The only direction you can go to making government smaller, is repealing the 16th amendment and abolishing the IRS. If they aren’t prepared to do that, which they won’t considering they are the ones that introduced it in the first place, then incrementalism to a smaller government doesn’t make any sense…..especially when you want to abolish the states rights to undo the marijuana laws they’ve passed. That’s not small government, that’s a tyrannical one that doesn’t want the states to have any rights outside of what big daddy approves of. As long as my pocket is getting pilfered by the Feds, there won’t be a smaller government.

  12. RE: The New GOP Health Care Bill Shows Republicans Have Given Up on Fully Repealing Obamacare
    Moderates want to keep Obamacare’s essential structure in place.

    1. Would someone again explain to me what the difference between the republicans and democrats is?
    2. Why is this so difficult? All the republicans have to do is repeal Obamacare and deregulate the healthcare industry (among others).

    1. You say that as if this is something Republicans actually want to do.
      They don’t want to actually deregulate – they just want to SAY they do.
      They fundamentally do not believe in deregulation.
      This shouldn’t be too difficult to understand.

      1. You are quite right.
        The republicans are nothing more than the socialist-lite party.

    2. Democrats believe in big government, and deficits are OK.
      Republicans believe in big government, and deficits are OK.
      Got it?
      (there are a few insignificant details on which parts should be big, but nothing material)

  13. A lot of people are here blaming the Republicans, and rightfully so in many respects. However, as to the straight repeal, last I checked they literally can not repeal the ACA even if 100% of Republicans voted to do so. They simply don’t have enough of a majority.

    Now instead of telling the American people that, they’re doubling down on stupid. I think it’s also pretty factual to say that many of them don’t actually want to get rid of the ACA at all.

    It’s disappointing to see the Freedom Caucus fold, either way.

    1. They can’t repeal it in it’s entirety, but they could get rid of an awful lot with reconciliation alone. When push meet shove though, they don’t even want to do that because the upheaval and political price would be terrible.

      Republican failure on this issue started the day after the ACA was passed, when they began to tell everyone that the problem with the ACA were all things they have absolutely no plan or intention of making better.

      1. Anything past ‘they can’t repeal it in it’s entirety’ doesn’t seem to really address most of the comments above bitching about that not happening when it’s a lawful impossibility.

        How much of the ACA could they really get through reconciliation? I don’t know. Frankly, I don’t really care. Pulling apart legislation like the ACA piece by piece is attractive, but it could be even worse than leaving it alone until you have the votes to simply trash it.

        The Republicans are squarely in a ‘damned if you do, damned if you don’t scenario’. Any ‘tweaks’ they make to the ACA will result in any of it’s failures being hung around their necks. Since it’s legislation that was always doomed to failure, well, yeah. If they don’t tweak it than people will blame them for it’s failures because they did nothing, regardless of if there was anything they could have done.

        I think everyone should probably just accept that the only solution is going to be single-payer healthcare in the United States. Yes, it’s a terrible and destructive idea but it’s what the public wants by-and-large. They will get it. There is no real hope that it won’t happen.

        1. RE: The Republicans are squarely in a ‘damned if you do, damned if you don’t scenario’

          This is born out of voters’ habit of blaming whoever is in power, regardless of what happens (even the weather. I’m serious on the weather thing, BTW). Taking power is a cruel double-edged sword, as it probably should be, but I don’t have a ton of sympathy for the people in power who suffer the downsides. You knew the job when you ran for office. The perils of the ACA fight in particular was laughably obvious.

          RE: I think everyone should probably just accept that the only solution is going to be single-payer healthcare in the United States. Yes, it’s a terrible and destructive idea but it’s what the public wants by-and-large.

          “Democracy is the idea that the people know what they want, and they deserve it good and hard.”

          If this proves to be true, I’m extremely curious as to the form that single-payer takes in America. As it stands, we are the only country that doesn’t have the government dictate costs to providers, as well as play a major roll as a provider. If that component(s) is not added to our system, single-payer could prove to be crushingly expensive along with all of the weaknesses of single-payer. Largely, we’d end up exactly where we are now: a kind of “worst of all worlds.”

        2. I still think the healthcare system that Mexico and other countries have makes sense. They have Seguro Popular – which is very basic Medicaid for all – but doesn’t cover everything, and then they have free market private insurers for those with more money and/or better jobs. Cover basic preventive care, life-saving urgent care, and stop subsidizing corn and subsidize healthier foods. A basic salad shouldn’t cost more than a hamburger.

  14. No surprise, last election they ran Romney the father of it with Ryan as his running mate. I only take issue with calling the republicans that won’t vote for repeal as moderates. Call them what they are, Big Government, Statists!

  15. Forget reconciliation. Write a law that repeals the ACA and all of the associated regulations effective 12/31/2019. This will give the industry time for the adjustments below. Use the “two speeches a day” rule, and pass it with a simple majority. No filibuster, no worries.
    Pass a “consumer protection” law requiring health care providers to charge the same to all customers, and publish those amounts. Allow the prices to change once a year in the second quarter. This kills the choice preventing “networks”. It also allows the actuaries time to prepare premiums for the next year.
    Pass a “consumer protection” law requiring insurance companies to pay the same amount for any procedure, and to publish those amounts in the third quarter.
    Now you can compare what you want to pay for insurance to what the provider you want charges, and pick the coverage you are comfortable with.
    Now that leaves us with the two problems. Existing conditions and poverty.
    Address those who cannot pay with direct subsidies. Food stamps for doctors, for example.
    Address existing conditions by allowing for reduced benefits during the first two years, like guaranteed issue life insurance. Create a “one time” period for the transition from the ACA where there would be some assistance for the currently uninsured to get on a policy. Now everyone has an incentive to get insurance and keep it, even if “healthy”. This beats the wait until you are sick scam, and is more fair than the “tax that is not a tax”.

  16. Character limits:
    Then sunset all that mess in 5 or 10 years, and get to a free market for both health care and health care insurance.

  17. I don’t see why this is so hard: just allow everybody who wants to to go into an unregulated, private market that’s not connected to the employer and can discriminate based on pre-existing conditions, and give them the same tax breaks as employer-based health care. You can even keep the mandate in place.

    Within a few years, no company will offer the ACA plans anymore. That’s because the ACA plans and regulations simply can’t function. You don’t need to repeal them at all, you simply need to allow the market to provide an alternative.

    You may add a few provisions to Medicare that allows people with no personal assets to buy into the plan at, say, 15% of their income.

  18. As I’ve been saying since 2009, a sizeable chunk (if not most) Republicans are fine with Obamacare. Many of the disastrous ideas behind the bill were their own. And now we are seeing them in true color, where they can’t hide behind empty Obamacare repeal votes.

    Republicans really only care about two things. Abortion and K-Street crony capitalism. They are perfectly happy outsourcing everything else to the Democrats, to do as they wish.

  19. Back to Work! | Barnhardt

    Folks, even the most cursory research shows immediately that Trump is and always has been fully in favor of so-called “universal” or “single-payer” healthcare. These psychopathic fools have no intention of ever undoing Obamacare ? only making it worse.
    I’m sorry, but if you were dumb enough to think that Trump or the congress would ever, ever, ever unwind the biggest racketeering matrix in human history, you deserve what you get. Keep writin’ those quarterly tax checks! I’m sure if the Republicans can just pick up a few more seats? OH. WAIT.


    1. When someone starts in with that “I have a secret, but I won’t tell you now ? I’ll tell you later” crap, the person is dishonest, doesn’t have anything, and is trolling for attention. Honest people don’t operate like that. I saw this quite a lot with the Obama birth certificate investigation, namely Sherriff Joe Arpaio and company. If you call a press conference and say “I have blockbuster evidence?” and then don’t deliver, you’re nothing more than a damn carney. Because objective reality sometimes gets in the way of our social life. My, we’d hate to be looked down upon by ? people on FACEBOOK! BIRFER!

  20. Hey, it’s my first time reading at this outlet.

    I’d be really interested to know people’s ideas on how healthcare should be provided.

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