The first Republican health care bill failed last month because it was too cruel for all Democrats and many Republicans, while insufficiently Randian for the most conservative members of the House of Representatives. Reviving the effort would thus require either a shift to the left significant enough to win over some Democrats, or lunging right and hoping that Republicans in moderate districts could be bullied into voting for whatever ultimately reaches the House floor.

The latest reports out of Capitol Hill suggest Republicans are contemplating the second option. The plan they are devising is so much more vicious than the failed American Health Care Act that—if it somehow passes the House and Senate, and President Donald Trump signs it into law—it will amount to a unified Republican statement that sick people deserve to fend for themselves, just as they did before the Affordable Care Act came to their rescue.

The linchpin of the plan—the key concession from GOP leaders that is likely to satisfy conservative House Freedom Caucus members—would allow states to waive not just the ten essential benefits that are required by the ACA, but its central risk-pooling provision, which prohibits insurance companies from charging sick customers more than healthy customers. It would, in other words, end the blanket federal ban on discrimination against individuals with pre-existing conditions, and, in some states, drive those people out of insurance markets altogether.

This would violate a central promise Trump made on the campaign trail, and the first principle he laid out to Congress in his February joint address—that “we should ensure that Americans with pre-existing conditions have access to coverage.” It would also violate a promise congressional Republicans made when they unveiled the American Health Care Act, that their bill would not repeal “patient protections, including for people with pre-existing conditions.”





In defending this new compromise, Republicans likely will deny that they are undermining protections for Americans with preexisting conditions. Freedom Caucus Leader Mark Meadows equivocated on precisely this point, as quoted by Huffington Post reporter Matt Fuller: