Ted Cruz is not going to save the day.
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Majority Leader Mitch McConnell is now courting the extreme right of his caucus, trying to get Sens. Ted Cruz (TX), Mike Lee (UT), Ron Johnson (WI), and Rand Paul (KY) on board with Trumpcare. That's after they endorsed the hard line repeal now, replace eventually idea trumpeted by popular vote loser Donald Trump. The idea was shot down pretty immediately by McConnell, but it worked to give those guys an extremist position from which to negotiate. So McConnell is appeasing them by sending an idea from Cruz to the Congressional Budget Office for scoring, along with a few other proposals.
This time, the CBO is evaluating several potential changes to the measure, including changing its Medicaid growth rate, providing more funding for opioid abuse prevention—and tacking on the Cruz amendment, which would allow states to opt insurers out of ACA regulations as long as they offered just one plan that's compliant.
The first two changes are for the moderates, making Medicaid die a little more slowly than in the original, and putting an insufficient pittance in to the opioid epidemic, possibly enough to make the moderates declare they got a win and to vote for the thing. The Cruz change, however, could drive them away again. It's also not likely to help the CBO score much, because it could end up in premiums so high for sick people that even insurance companies don't like it.
Insurance groups and policy experts warn, however, that this approach would create instability in the individual market by fragmenting the risk pool and driving up premiums for sicker people who need expensive care. They say it would turn the market for ACA-compliant plans into a de facto high-risk pool, but without an adequate, dedicated funding stream to make that model viable.
"Insurers are concerned that would make it challenging to keep premiums low for everyone," said an insurance industry official who did not want to be named.
"The sick would be attracted to generous plans, while the healthy would be attracted to cheaper plans, with the knowledge they could always move into more generous plans if they got sick," said Craig Garthwaite, a health insurance expert at Northwestern University. "That kind of adverse selection makes pricing and offering insurance very hard."
Protections for people with pre-existing conditions would thus be an extremely theoretical thing, though Republicans will insist they're maintaining them. It's the same old idea Republicans have been pushing for years—high risk pools—with a slightly different mechanism that would strain insurance companies, and really destabilize the individual insurance market. Sure the maniacs love it because somehow it's all about freedom, but it should drive any of the so-called moderates much further away.
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