Sarah Kliff reports on the latest from House conservatives:
The House Freedom Caucus laid out two demands on Thursday for a health care bill its members would support: ending Obamacare’s essential health benefits and its “community rating” provisions.
Good for them! I’m serious. The key starting point for any kind of comprehensive health care plan is a ban on turning down customers with pre-existing conditions. But once you do that, you have to control the price insurers can charge (aka “community rating”), or else they’ll simply jack up premiums for people with expensive conditions to a million dollars per year, which accomplishes the same thing as turning them down. But if insurers are required to cover anyone who applies, they also need plenty of healthy people to balance out their risk pool. So you end up with an individual mandate. But if you have a mandate, you have to have subsidies for poor people. You can hardly expect to legally require insurance for people who don’t have the money to buy it, after all.
At that point, you have the entire edifice of Obamacare. There’s no way around it. That’s why Paul Ryan’s plan looked an awful lot like Obamacare lite.
So if you’re a conservative who flatly doesn’t want an expensive, comprehensive, government-funded health care program, there’s only one way to get there: ditch the pre-existing conditions ban by calling for an end to community rating. This is hugely unpopular, so it takes some guts to tell the truth and propose getting rid of it.
It’s also cruel and meanspirited, but that goes with the ultraconservative territory. But at least they’re being honest. Compare this to Paul Ryan, who kept the pre-existing conditions ban (via his “continuous coverage” provision), which then forced him to accept all the bells and whistles of Obamacare. His solution was to wave his hands and then keep the funding so low that his program essentially did no good at all. He didn’t have the stones to simply admit that what he really wanted to do was repeal Obamacare and then do nothing at all to replace it.
Now, it so happens that Obamacare’s pre-existing conditions ban has no direct effect on the federal budget, and therefore can’t be repealed via reconciliation. It can only be repealed under regular order, which requires 60 votes in the Senate. So the Freedom Caucus folks are out of luck. But at least they’re displaying a bit of honesty.