The Congressional Budget Office score on the House Zombie Trumpcare bill was scathing when it came to amendment that got Speaker Paul Ryan the votes he needed to pass it, the waivers for states to decide whether or not to keep protections for people with pre-existing conditions. The CBO found that it would mean lower premiums for young, healthy people in those states, but that premiums could be unaffordable for people with pre-existing conditions. In states that decided to waive coverage regulations, for example, people could pay more than $1,000 per month for maternity coverage. That's not sitting well with plenty of Senate Republicans, but the number three guy in Mitch McConnell's leadership team says it's a go.
Sen. John Thune (S.D.) said he thinks a Senate bill will allow states to waive some requirements for insurers.
“I think there will be some authorities for states because, like the House, we want to give the states as much flexibility as possible,” said Thune, the No. 3 Republican in Senate leadership. […]
Asked how the Senate would avoid raising costs for people with pre-existing conditions, Thune said: “That’s what we have to try and do is come up with options in our version of the bill that prevent those types of outcomes.”
How you do that is how Obamacare did it—you don't allow insurance companies (or states) to discriminate on the basis of health history. It's not rocket science. McConnell and Thune have a problem, though, in insisting that this "flexibility" for states is in the bill. For example, Sen. Dan Sullivan (AK), who flatly says "no waivers." (Alaska is already slammed under Trumpcare, with the highest potential increases in the nation—an average of $12,599 more per year in out-of-pocket costs.)
On the other side of the spectrum, there's Sen. Ted Cruz (R-TX) and his trusty sidekick Mike Lee (R-UT). Cruz says that "If we're going to lower premiums, we have to give consumers flexibility to be able to purchase more affordable plans," and that states will have to have the "flexibility to innovate to provide creative solutions so that those in need receive better care." In other words, no protections. His little buddy Lee wants to double-down on getting rid of the protections, repealing all of them and then letting states opt back in. Not sure that Lee has thought one that out all the way, since if it's all repealed, there won't be anything for states to opt in to, and then the states would have to pass them.
Then you've got people who are just confused, like Sen. John Hoeven (ND) who says he wants "states to have flexibility," but you also have to have "some kind of federal support or backstop like a risk pool or reinsurance so that people are comfortable that for chronic illness and pre-existing conditions." He admits that the House bill didn't have enough funding for those things. And you also have Sen. Bill Cassidy (LA) who says "any bill that passes the Senate must meet the 'Jimmy Kimmel test,' referencing an impassioned speech the talk show host gave in support of protecting those with pre-existing conditions." He would accept state waivers, he says, with "very robust" funding for something like risk pools. What neither address is the fact that providing enough funding for those things would never pass in the House.
But, hey, the Senate staff has next week to figure all that out and draft a bill, while the senators are back home avoiding talking to constituents about health care. They'll all come back to DC, and it will be up to McConnell to strong-arm them all into agreement.