Neobamacare 2.0: House Passes New AHCA That Still Doesn't "Repeal Obamacare"

If you don’t follow the news out of Washington carefully, you’d hardly know this was coming. The House today passed a new version of the American Health Care Act on a close 217-213 vote (20 Republicans voted against). Republicans are cheering, saying Obamacare has been repealed and replaced. It hasn’t.

This new bill does not repeal the Affordable Care Act in full, or even close. It eliminates three main planks: the individual mandate to purchase health insurance, the employer mandate to offer health insurance, and certain taxes that funded parts of it.

The rest of the “repeal” it leaves up to the states. It allows states to apply for waivers (that Secretary Price will undoubtedly approve) remove most of the mandates on insurance companies to cover certain things. These mandates drove up premiums and deductibles, but Democrats got to claim everything was covered for everyone, even though that coverage was largely unaffordable.

The “affordable” part only came at the bottom of the spectrum, where the poorest customers got subsidized coverage on the state and federal insurance exchanges. Unfortunately the inevitable rising costs that accompany government subsidies in any market also priced most insurers out of that system, leaving a large part of the country with no choice in where they get coverage.

And that’s where we get to what the AHCA keeps from the ACA. Exchanges stay. Subsidies stay, but in the new form of recalculated tax credits. Medicaid expansion stays, but Medicaid gets block granted to states instead of managed by CMS in DC. Preexisting conditions, the great bogeyman of the health care debate, must be covered, but state waivers might make that coverage cost more.

We simply don’t know what effect the law’s new provisions will have on both the health care market and the federal budget. That’s because it was only released today and has not been scored by the CBO, both of which violate previous promises by House leadership.

Paul Ryan in 2009: “I don’t think we should pass bills that we haven’t read that we don’t know what they cost.” #Awkward pic.twitter.com/7AA9i1McqN

— Josh Jordan (@NumbersMuncher) May 4, 2017

Fortunately without that CBO score we can avoid the wailing and gnashing of teeth about how many millions will “lose” (read: choose not to purchase) coverage under the new bill.

Needless to say, the AHCA will still have to pass through the Senate, where procedures are much tighter and futures far less certain. It will likely look far different if it passes there and heads for President Trump’s desk for the inevitable tickertape parade (and media meltdown).