The AHCA action has moved to the Senate.
which has settled on a 13-member working group to draft a health care bill. Vox’s Dylan Scott has a list of the members: It ranges from Sen. Portman — a moderate who is concerned about cutting the Medicaid expansion too heavily — to Sen. Lee, a conservative who would like to see Obamacare wiped off the books entirely. The idea is that if there is a health care bill that can fly with this group of legislators, it can probably survive the rest of the caucus too. The working group notably does not include Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) , who have spent this session working on that would allow some states to keep the Affordable Care Act and others to opt out. That is a bill crafted for compromise with Democrats — which is something neither party seems to be in the mood for these days. Legislators who voted to pass the American Health Care Act sure don’t appear eager to talk about that decision. According to data provided by, only nine Republicans who supported the bill currently have events scheduled during next week’s recess. Those House members are: The MacArthur event, which will happen next Wednesday evening, could be the most interesting to watch, given MacArthur’s key role in drafting the AHCA — particularly adding the amendment that would allow states to waive Obamacare’s requirements that insurers not discriminate against people based on their preexisting conditions. When Republicans explained Thursday why they needed to repeal Obamacare, they kept talking about the same thing: Iowa. A few examples from Thursday: Health insurers have fled the Iowa marketplace quickly, in a way that is not happening elsewhere in the country. For the past four years, Iowa had a relatively competitive marketplace. There were four insurers that sold in different areas of the state. Things started to take a turn for the worse in April. Wellmark (Iowa’s largest health plan) and Aetna announced in April that they would quit the marketplace. This left one insurance plan, Medica, as the only insurer left in 94 of Iowa’s 99 counties. It then released a statement this week saying it was considering leaving the marketplace — but hadn’t made up its mind. Wellmark said it lost $90 million on the marketplace during its four years in business. It thought there was a way to fix this problem — to become profitable in the individual market — but the current administration didn’t seem interested in going down that path. “While there are many potential solutions, the timing and relative impact of those solutions is currently unclear, ” Wellmark chief executive John Forsyth said in a statement. “This makes it difficult to establish plans for 2018.” Same story with Aetna, which said it was leaving as “a result of financial risk and an uncertain outlook for the marketplace.” Then comes Medica, with its statement this week. Medica too cited the uncertainty around the health law’s future as making it skittish on sticking with the Obamacare marketplaces. The marketplaces were not working perfectly under the Obama administration. But part of the reason insurers have soured on them, in Iowa and elsewhere, is the Trump administration has played coy about what it plans to do with Obamacare next year. Officials have been aggressively ambiguous, for example, about whether they plan to pay Obamacare’s cost-sharing reduction subsidies. An uncertain marketplace is less attractive to health insurance plans. As industry consultant Robert Laszweski told me a few weeks ago, “The health plans I work with want to stay in, but the Trump administration is not making that easy.” There is reportedly a patient in the Iowa marketplace who has about $1 million in monthly medical claims. This person enrolled on Wellmark in 2016, and because of their exceptionally high bills, the insurer had to raise premiums. Insurers in Iowa are nervous about being the last one standing, because then they’d end up with this one person to cover. This is an anomaly in the Iowa marketplace that we so far haven’t seen play out anywhere else. My colleague Tim Lee wrote for the famed economist William Baumol, whose cost disease theory explained why health care and education costs grow so much faster than other parts of the economy. Tim describes this graph as his favorite chart of the American economy.
