Though an interesting month of activity for healthcare reform, we have no consensus as we embark on a two-week break where Congressional members will be in their home states.

Since the infamous Friday, March 24—when House leadership prevented the American Health Care Act (AHCA) from a House vote—Vice President Mike Pence and others have been looking for the magic ingredients to create a healthcare reform bill that is palatable to everyone.

One of the biggest hurdles is creating buy-in from the Freedom Caucus, a conservative faction of the Republican Party, whose backing is necessary to achieve enough Republican votes to pass a bill through the House. In an effort to move things forward, Vice President Pence continues to meet with the Freedom Caucus and is making offers to include certain provisions in the AHCA.

In an interview on April 6, Representative Mike Meadows, chairman of the Freedom Caucus, said that if all the provisions make their way into the AHCA, “the majority, if not all, of the Freedom Caucus will vote for this bill.” He was quick to say they want to continue the protection on pre-existing conditions and making sure healthcare remains affordable with the primary objective being lower insurance premiums. The other items they are looking for include state waivers that exempt the requesting state from certain provisions of the Affordable Care Act (ACA).

The waivers could allow States to:

  • Remove the requirement that all plans in the individual and small group markets include the ten essential health benefits
  • Modify community rating rules, with the exception of gender (the ACA mandates that all plans in the individual and small group markets be rated only family coverage tier and number of family members, and geographic area and prohibits rating based on gender or health conditions)
  • Eliminating guarantee issue, the provision that guarantees that all individuals and small groups applying for coverage get coverage

These waivers are contingent upon the addition of a new “Federal Invisible Risk Sharing Program” that prevents healthcare premiums from rising. This type of risk pool allows individuals to purchase the same coverage as others at comparable costs but helps provide insurance carriers with additional dollars to help offset the costs of the sickest individuals.

As Congressional members head home for the recess let’s hope that absence makes the heart grow fonder. We hope they return with new positivity and drive to enrich the healthcare system for all.

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