Friday, April 28, 2017

Trumpcare 2.0 Sign of Political Weakness

Trump is being ridiculed for a second rushed attempt to repeal Obamacare. The accepted point of view is that he is taking a stab at Trumpcare 2.0 in order to have a legislative achievement to celebrate his 100 days in office, which occurs this weekend (Saturday). But more importantly I think Trump knows how to read his base. His flipflopping on almost every single campaign promise has left him vulnerable, even if his (poor) poll numbers show that his stalwart backers are not abandoning him (for now).

If there is one issue on which the Trump True Believer can't abide a flipflop, it is the repeal of Obamacare. The fact that Trump can't wrangle it through the House is proof of his political weakness.

Trumpcare 2.0 brought on board the assassins, the Freedom Caucus, of Trumpcare 1.0 by allowing states to seek waivers from the federal government in order to dispense with basic features of Obamacare -- providing essential benefits, as well as the restriction on charging more to those with preexisting conditions. But Trumpcare 2.0 apparently lost moderate Republicans afraid of voter wrath for taking coverage away from sick people. As Thomas Kaplan and Robert Pear explain in "Health Law Repeal Will Miss Trump’s 100-Day Target Date":
The latest House plan to repeal and replace the health law would include an amendment drafted by Representative Tom MacArthur, Republican of New Jersey and a leader of a centrist bloc of lawmakers called the Tuesday Group.
Mr. MacArthur’s amendment would allow states to opt out of certain provisions of the Affordable Care Act, including one that requires insurers to provide a minimum set of health benefits and another that prohibits insurers from charging higher premiums based on a person’s health status.
Republicans say the federal mandates drive up costs, but Democrats say they provide important protections for consumers.
Under Mr. MacArthur’s amendment, states could obtain waivers letting them redefine the “essential health benefits,” which now include maternity care, emergency services, mental health care and drug addiction treatment.
Republicans say their bill maintains protections for people with pre-existing conditions. But Democrats say the waivers would severely weaken these protections because insurers could charge higher premiums to sick people who wanted to buy insurance after a gap in coverage.
Republicans say their bill offers billions of dollars that states could use to operate high-risk pools or other programs to provide or subsidize insurance for people with pre-existing conditions.
The American Medical Association and AARP, the lobby for older Americans, oppose the latest version of the Republicans’ health care bill.
“Although the MacArthur amendment states that the ban on pre-existing conditions remains intact, this assurance may be illusory, as status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions,” said Dr. James L. Madara, the chief executive of the American Medical Association.
Mr. MacArthur said Thursday that his amendment had won over some of his Republican colleagues, though not enough to pass the bill. “But we are closer today than we’ve ever been,” he said. “We’re getting there.”
At the same time, his amendment highlighted the gulf between hard-line conservatives and more moderate Republicans when it comes to how to go about repealing and replacing the Affordable Care Act.
For the Freedom Caucus, which shouldered much of the blame for the House bill’s failure last month, the amendment functioned as a way to shift any finger-pointing to a different bloc of members.
But the latest version of the House bill seemed to offer little that would entice anyone with reservations other than the hard-line conservatives.
“The proposed changes to this bill would leave too many of my constituents with pre-existing conditions paying more for health insurance coverage, and too many of them will even be left without any coverage at all,” Representative Ileana Ros-Lehtinen, Republican of Florida, said Thursday.
The Senate Democratic leader, Chuck Schumer of New York, argued on Thursday that the core of Mr. MacArthur’s amendment would violate the budget rules that Republicans must follow in order to sidestep a Democratic filibuster.

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