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President Trump headed into the Oval Office on the promise of repealing and replacing the Affordable Care Act (ACA), which is better known as Obamacare. Yet, more than three months into the Trump presidency, the ACA remains firmly entrenched as the health law of the land.
This isn't, of course, for a lack of effort to replace the ACA. In early March, President Trump and his Republican colleagues debuted a replacement known as the American Health Care Act (AHCA), which some pundits have dubbed as "Trumpcare." However, the AHCA was never put to vote in the House because it couldn't garner enough support from Republicans. Some Republicans felt the AHCA didn't go far enough to distance itself from Obamacare, while others felt it went too far and disadvantaged lower-income folks.
Image source: President Donald J. Trump official Facebook page. Photo by Shealah Craighead.
The failure of the AHCA to move to vote and Trump's insistence that lawmakers focus on tax reform was viewed by many as an indication that health reform was dead, at least for a while. But, that's not proven to be the case. Republicans have, behind closed doors, been working on adjustments to the AHCA that will allow it to appeal to more GOP lawmakers. Remember, Republicans control both houses of Congress and the presidency, so if lawmakers voted strictly along party lines and the budget reconciliation process were used, the GOP could get its bill passed.
Last week, Trumpcare version 2.0 was released.
The new health plan looks almost identical to the first, but with one key change. Before we dive into the change, let's rehash the key components of what the AHCA would do.
Image source: Getty Images.
The major difference between the initial plan above and the newly leaked Republican health bill is that it would allow states certain waivers should they choose to exempt themselves from essential health benefit requirements or community rating rules.
According to the leaked document via CNBC, states would be able to apply for and receive this waiver if they can,
Attest that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions.
Why the change? Freedom Caucus Republicans had refused to support the initial version of the bill because it retained a number Obamacare's Title 1 regulations. These are the mandates that govern what the insurance industry can and can't do. Initial estimates have suggested that the addition of state waivers could sway a good number of these lawmakers to a "yes" vote, giving the bill enough momentum to reach the Senate. There it'll likely undergo a few more changes.
Allowing states the ability to decide whether they apply for these waivers, which is really similar to ruling from the Supreme Court that allows states to decide whether or not to expand their Medicaid programs, also might take some of the heat off Congress if things don't go well.
Image source: Getty Images.
Ultimately, though, this change isn't good news for the consumer. Let's take a look at why you're probably not going to be happy with Trumpcare 2.0.
If a state were able to prove any of the conditions above and wanted exemption from some of the AHCA's key provisions, here are some the scenarios that could occur:
In other words, these changes would allow certain states to mold their own health plans, which would almost certainly be a boon to the insurance companies, and would likely pass along higher out-of-pocket costs to the consumer. Even with lower premiums, we could be talking about substantially higher costs when it comes to receiving medical care via higher deductibles and copays.
There's not a lot for consumers to like about this new provision, albeit it may make the AHCA more sustainable for insurance companies over the long run since it passes along these added costs to the consumer.
For now we can only watch and wait to see if Trumpcare 2.0 is put to vote.