The Transom, Ben Domenech, April 26, 2017

While most of Washington is focused on the question of Trump’s tax plan, on the health care side, it’s once more unto the breach.  “The White House, top House conservatives and a key moderate Republican have finalized a new Obamacare repeal and replace plan they hope will break a month-long logjam on a key priority for President Donald Trump. But it is far from clear that the fragile agreement will provide Speaker Paul Ryan the 216 votes needed for the House to pass the stalled legislation.

“The million-dollar question: Can Freedom Caucus Chairman Mark Meadows, who helped author the changes, deliver the votes needed to get the bill over the finish line? The North Carolina Republican is said to support the amendment, sources say, but it’s still unclear how many of his group will flip from “no” to “yes.” …

“The new agreement gives the Freedom Caucus some additional concessions, including waivers that allow states to opt out of major Obamacare regulations touching on essential health benefits and when insurance companies can charge higher premiums.”

In a Q&A with conservative journalists yesterday, Trump indicated the measure might not come up til September.  But the real takeaway from this approach is that Hill Republicans lack the will to get rid of Obamacare’s regulatory structure via legislation, despite the necessity of doing so. Chris Jacobs outlines how this state waiver process would work – waivers could be applied for on three bases:  “Beginning in January 2018, vary rating by age more than Obamacare (current law says that insurers cannot charge older individuals more than three times the premiums paid by younger enrollees);

“Beginning in January 2020, set their own essential health benefits—the categories of services all insurance sold must cover; and

“Beginning after the 2018 open enrollment period, permit insurers to vary premiums by health status and/or eliminate the mandatory 30 percent penalty for individuals who do not maintain continuous insurance coverage—provided that the state has established a program of actual or invisible high-risk pools, or some other mechanism through the bill’s Stability Fund to stabilize its insurance markets.

“Some conservatives may have philosophical concerns with this approach, on several levels. It perpetuates a federal regulatory regime for health insurance, maintaining Obamacare as the default option. Not only does the bill take the position that “If you like your Obamacare, you can keep it,” it ensures that states will keep Obamacare unless and until they affirmatively do something to opt out of the law—a position that turns federalism on its head…

“The above concerns notwithstanding, the waiver debate has put paid to the notion that Congress cannot repeal Obamacare’s major insurance regulations as part of a repeal bill passed through budget reconciliation. In other words, the question is not one of process, and what the Senate parliamentarian will allow, but one of political will—whether Republicans want to repeal Obamacare or not.”

Whether Senate Republicans stick with this format or not, it represents a significant backing off from GOP commitments of full repeal. Instead, it is a classic example of Republicans offering less-bad alternatives to bad policies. Whether voters view it as delivering on their promises or not is an open question – and the answers are surprisingly vague given the importance of this decision.