The White House and a pair of influential conservative advocacy groups have endorsed a proposal by Sen. Ted Cruz (R-Texas) that would allow health insurers to offer cheaper, less-comprehensive plans as long as they also offered at least one plan that includes the essential consumer protections required by the Affordable Care Act. Senate Majority Leader Mitch McConnell (R-Ky.) has sent Cruz's proposal to the Congressional Budget Office for cost-benefit analysis.
Wednesday's endorsement of the Cruz amendment by the leaders of FreedomWorks and the Club for Growth "is significant: Without at least a neutral stance from conservative groups, it could be impossible for McConnell to find the 50 votes needed to pass a repeal this month," Politico reports. "But what the right is asking for may not be able to pass the Senate." The proposal may well violate budget rules that McConnell is using to push through his bill with 51 votes, and more centrist senators and outside insurance experts are concerned that it would essentially price people with pre-existing conditions and other high medical needs out of the insurance market.
"People who have higher health-care needs and need more comprehensive coverage would choose ACA-compliant plans," said Cori Uccello at the American Academy of Actuaries. "People who are healthy now would tend to choose noncompliant plans with really basic benefits. People who want or need more comprehensive coverage could find it out of their reach, because it might become unaffordable." Sen. Susan Collins (R-Maine), who was frequently thanked during July 4 festivities for helping at least slow down the bill, agreed that the Cruz language "would lead to adverse selection in the marketplace," adding: "It would also vitiate the important consumer protection of having a prohibition against annual and lifetime caps" on benefits.
Cruz and his allies argue that the amendment would lower premiums and allow individual consumers to essentially opt out of ObamaCare, but touching the pre-existing condition language may be a deal-breaker for other Republicans. "Sen. Lamar Alexander of Tennessee is speaking against it in caucus lunches and Sen. Deb Fischer of Nebraska, a staunch conservative, also vocally opposes Lee and Cruz's idea," Politico says. "Many senators believe that the House made a critical error by allowing states to opt out of pre-existing condition protections and are determined not to touch that part of ObamaCare." A Senate vote could come as early as next week.