Republicans, hell bent on passing a healthcare replacement bill that nobody wants, have snuck in several provisions making the bill somehow even more terrible than the original one they drafted.
One of the major changes to this version of the draft, introduced by House Freedom Caucus member Rep. Tom MacArthur (R-NJ), allows states to opt out of the Obamacare requirement that insurers cover those with pre-existing conditions (a far-ranging term which apparently also includes rape). This means that companies in waiver states will be able to discriminate against anyone with a pre-existing conditions, increasing premiums or denying coverage all together. Instead, states who ask for waivers can receive funding for high-risk pools, but critics say the allocated $8 billion in funding over the next five years is inadequate and that high-risk pools often lead to increased premiums and lower coverage for those who need it most.
The Wall Street Journal reports that even Americans who receive insurance through their employer “could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses.” Currently, Obamacare bars employers from setting annual limits on coverage or lifetime limits on 10 essential health benefits (like maternity care, emergency room visits, prescription drugs, and more) and allows employers to choose coverage from insurance providers from any state. This was a moot point under the ACA, since all states were required to provide coverage of the essential health benefits, including those with pre-existing conditions. But under the new bill, experts say that employers could flock to waiver states that require less from insurance companies and could enforce caps on insurance coverage.
The bill also slashes Medicaid funding, ending the expansion program by 2020, cuts taxes for the wealthy, and actively disadvantages the sick and poor.
Republicans seem to be aware of how bad their plan is because the bill includes a loophole that exempts members of Congress from losing provisions currently protected by Obamacare. After Vox reported on the exemption, rather than closing the loophole, House Republicans said they will introduce a separate bill to roll back the exemption—but that would need 60 votes to pass in the Senate.
On top of all of that, as Ezra Klein notes in Vox, Republicans are rushing Thursday’s vote without an assessment by the Congressional Budget Office or a consensus that the bill has the votes it needs to pass. Without the CBO’s review, we don’t know the full impact this bill will have on Americans. But if the failed March draft is any indicator, at least 24 million more Americans will be uninsured by 2026. As of Thursday morning, the bill’s text has still not been posted.