The introduction of this concept seems like a good development, and it may point the way toward further ideas that are also, in a sense, native to the constraints of reconciliation.
One forbids insurers from charging higher premiums on account of people's medical problems or pre-existing conditions. In their place: intra-party fights over how to replace the law or whether or not to keep popular provisions like coverage for people with pre-existing conditions. To tackle the biggest overhaul of the USA tax code since the Reagan era quickly, House Republicans need to avoid the political fault lines that sank their healthcare bill, partly by having conservatives on board.
The Freedom Caucus, meanwhile, insisted it was offered more including the opportunity for states to apply for waivers to repeal the community rating provision, which dictates insurers can not charge people more for insurance based off of medical history.
While high risk pools are a favorite policy among Ryan and conservatives, they have a very checked past in the states where they existed prior to Obamacare.
Major hospital and medical groups, including the American Medical Association, were opposed to the initial Republican bill because it would lead to massive coverage losses and cuts in hospital revenue.
Later Tuesday, Rep. Steve Scalise, R-La., his party's chief vote counter, said discussions were not "where there is consensus" on health care and indicated a vote this week was unlikely.
The conservative Club for Growth piled on, accusing Republican moderates of torpedoing a potential deal. Three sources familiar with the meeting told Politico it was made clear that Ryan is not the only House Republican whose job is on the line.
Moderates, in turn, blamed conservatives for constantly altering their demands. "I have never campaigned on a mere repeal, ever".
Rep. Diane Black, R-Tenn., said she is encouraged because "I think two sides talking to one another gives me optimism". The more controversy, they blast out an email, they gin up their supporters.
It's true: Conservatives love them some states' rights. Rep. Mark Meadows, R-N.C., who chairs the House Freedom Caucus, remained optimistic, given continuing talks.
"There is still an opportunity for compromise on this, but I think it still needs more time,"he said".
Speaker Paul D. Ryan orchestrated a broad show of Republican support for the proposal, conceived as an amendment to the repeal bill that collapsed on the House floor two weeks ago. "So my understanding of the impact of insurance regulations is real".
While Collins was taking aim at the Freedom Caucus, the head of that group was counseling patience, expecting more talks in the weeks ahead. "The White House hasn't nailed it down", according to CNBC.
The amendment would set aside some more money to help lower premiums for sicker people, providing $15 billion for states to reimburse health insurers for covering those patients, who often are more costly.
The standardized rates are made possible by a concept known as "community rating", in which everyone in a pool of enrollees pays the same premium so that the costs of sicker, more expensive plan members are spread across all those who buy coverage.
Under the White House proposal, states could apply for a federal waiver from a provision in Obama's law that obliges insurers to cover "essential health benefits," including mental health, maternity and substance abuse services. One rule, that benefits once conferred on the American people can not be taken away, was a primary reason for the collapse of the GOP health care plan. President Donald Trump needs to score a short-term win on the issue, the vice president emphasized, since otherwise lawmakers may retreat.