Negotiations over a Republican health care plan to replace Obamacare appear to have reignited with great fervor this week, with the White House and the conservative House Freedom Caucus in talks about a new health care plan.

The Washington Examiner gives a good sense of where the negotiations are — and, if it’s right, suggests Republicans are on track to push a bill less popular than their first effort, the American Health Care Act:

Freedom Caucus members, whom Trump has blamed for the implosion of his first healthcare deal, want to see Obamacare's Title I insurance regulations dismantled in the GOP legislation. The Freedom Caucus source said White House officials "could get 216 for the [American Health Care Act] today if they included language to strip out the Title 1 insurance regs."

Title 1 is the heart of Obamacare’s coverage expansion. It runs 374 pages. It includes the requirement that insurers offer coverage to all Americans. It bars insurers from charging higher rates to people who are sicker or to women, a standard practice in the pre-Obamacare market. It outlaws lifetime limits on how much an insurer will pay — before the Affordable Care Act, 55 percent of employer-sponsored plans had a cap on benefits, usually around $1 million or $2 million. It is also the part of the law that requires insurers to cover young adults up to age 26.

Title 1 includes the requirement that insurers cover 10 “essential health benefits” including maternity care and mental health services, and a mandate that all insurers cover preventive care without any cost to the patient. Title 1 also says that insurers have to provide consumers with easy-to-understand summaries of what their health plan actually covers.

The Freedom Caucus has indicated it wants to target two of these provisions specifically: essential health benefits and “community rating,” which is the requirement that insurers charge sick people the same prices as healthy people.

The Freedom Caucus’s changes would hurt the poor and the sick

Getting rid of essential health benefits and community rating would almost certainly create a bill that is less popular and covers fewer people than the Republicans’ first proposal, which would have caused 24 million people to lose coverage. The change would allow insurers to once again charge sick people higher premiums than the healthy — meaning premiums would often be too expensive for low-income Americans with preexisting conditions to afford.

This would also mean that insurers could stop covering services that tend to attract patients who use more medical care, like maternity coverage and mental health services. Before the essential health benefits requirement, just 12 percent of individual market plans covered maternity benefits, for example. Twenty-two states had mandates requiring the coverage of mental health treatment before Obamacare — which meant 28 states didn’t.

Republicans have argued that these essential health benefits drive up premiums, and they are right. Whenever insurers have to pay for more medical care, the cost of the health plan goes up. Obamacare’s defenders say these are the basic health benefits everyone should have access to, and it is worth spreading their costs across all people buying coverage.

Whether the Freedom Caucus keeps its aim on these two provisions or goes wider — targeting lifetime limits, for example — the winners and losers are already clear. People who are healthy would have something to gain with less insurance regulation. They would be able to buy skimpier plans that charge lower premiums but also offer fewer benefits.

But people who are sick and poor have a lot to lose. Their premiums would go up because of the return of individual rating, and their benefit packages would shrink because of the end of essential health benefits.

A bill that ends community rating and essential health benefits would almost certainly drive up the number of people who lose health coverage. Many Republican legislators were not okay with the coverage loss under the last bill, and certainly would not get on board with an increase.

About 17 percent of Americans supported the last Republican bill, the American Health Care Act. The ban on charging for preexisting conditions is one of Obamacare’s most popular provisions. By toying with eliminating it, Republicans are also toying with drafting an incredibly unpopular new plan.

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