Swampcare 2.0: Let’s Do Nothing!

Vice President Mike Pence had a pow-wow with Congressional Republicans

Both moderates and conservatives, Monday, prior to the administration unveiling Strike Two of “Repeal Obamacare,” which will be heretofore be known as Swampcare 2.0.

The first thing he did was change basically nothing. From Roll Call:

Rep. Chris Collins, R-N.Y., said the pitch dropped a controversial last-minute amendment proposed in March that was intended to win over House conservatives. It would have ended the health care law’s requirement that every insurance plan in the marketplaces cover 10 categories of health care benefits.

Wait, but there’s more.

Instead, the White House proposal offered to let Health and Human Services Secretary Tom Price work with states who want to waive the requirements, if they have a plan in place to ensure costs drop and access remains the same or improves. The change resembles a provision in current law known as a 1332 waiver. The White House also presented to moderates changes that would more specifically target a $115 billion fund in the package aimed at stabilizing state marketplaces.

A “1332 waiver” is named after ACA Section 1332, which permits states to apply for a State Innovation Waiver. The National Conference of State Legislatures had this to say about 1332.

Beginning Jan, 1, 2017, a new state option within the Affordable Care Act (ACA) took effect, known as Section 1332 Waivers*. For the first time since the law was signed six years earlier, this new process may allow any state to seek to modify key parts of the health law within its boundaries. While in effect, these 1332 waiver options offer states an opportunity to fashion a new coverage system customized for local context and preferences while still fulfilling the aims of the ACA. The statute requires interested states to pass authorizing legislation as an early step in order to apply for and ultimately implement waiver-based reforms.*

So, basically, Swampcare 2.0 simply replaces a code section that’s already law in the current ACA with something that resembles the current law. In mathematics, when two things are equal to a third thing, the two things are also equal to each other. A = C and B = C means A = B.

Therefore, Obamacare + § 1332 = Obamacare as of Jan. 1, 2017 = Swampcare 2.0. The new proposal doesn’t repeal the core requirement of health insurers to offer standardized coverages, but does allow states to ask “Mother May I?” to HHS for a waiver. What sorcery is this?

Some states already had waivers on file, others didn’t, and now that many states (including Georgia) legislative sessions have ended, we’ll see a whole lot of confusion if this mess passes. It’s honestly better to just leave 1332 alone if you’re going to replace it with something equivalent but differently administered. I thought Trump was against paper chases and inefficiency. Apparently not.

To their credit, the House Freedom Caucus was having none of this. Despite spin indicating a “deal” was made, there is no deal–certainly not before the text of the bill has been reviewed. Unlike Nancy Pelosi’s Democrats, the HFC doesn’t “pass it so we can see what’s in it.

Without more to offer conservatives, and giving more control back to states, it’s unlikely that Swampcare 2.0 will get further than its predecessor. So far, it’s a big, heaping plate of nothing.

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