Trumpcare 2.0 isn't much better than its predecessor

President Trump said if the Ryan "Obamacare Lite" bill failed, there would be no more efforts to repeal Obamacare.  He then proceeded to trash the House Freedom Caucus and to demand their ouster in the 2018 primaries.

But that was last week.

This week, there are news stories indicating that President Trump's people are negotiating, behind the scenes, with the Freedom Caucus on an Obamacare repeal compromise.  One of the major problems the Freedom Caucus had with the Ryan bill was that it did not repeal the "essential health services" requirement, which required all policies to cover a number of very expensive options.  For example, one essential service is providing unlimited health coverage.  If one person needs ten million dollars of health care, it raises the premiums for everyone else.  Another is requiring insurers to insure people with pre-existing conditions.  People who waited until they got sick before getting insurance are "free riders," having paid nothing into the system but forcing everyone else with insurance to pay for them, again with higher premiums.

The compromise being worked out would allow states to apply for a waiver that would permit insurers in their states to issue policies that do not cover what the Obama administration considered essential health services.  That way, at least "red state" Americans could enjoy the lower premiums that would result from being able to buy policies without all sorts of mandates built into them.

Among the changes intended to woo conservatives is a proposal to let states seek a federal waiver from key Obamacare regulations they say are driving up health insurance premiums.

One option being considered, for instance, would allow governors to opt out of Obamacare's "community rating" provision, a protection that prohibits insurers from charging sick people higher premiums. That measure would be coupled with an increase in dedicated funding to bring down premiums for the sick.

In practice, however, such a compromise would be no compromise at all.

1) People in blue states would still be locked into paying higher premiums, since their Democrat legislatures would not seek such waivers.  People in blue states would be denied any relief, and believe it or not, there are actually some Republicans in California and New York.

2) The waiver system would last only until a Democrat became president.  Once that happened, he could simply rescind the waivers and require all states to cover all "essential health services."  It would not even take an act of Congress.

3) By letting states individually opt in or out of "essential health services," we are deprived of interstate competition among insurers.  We need that greater competition to lower premiums, especially in underserved markets with only one or two insurers.

Some conservatives in Congress recognize this.

"I don't know of a single Republican that got elected promising to be generous with waivers from our all-powerful position," said Rep. Louie Gohmert (R-Texas), who said the proposal would still fall short of a full repeal of Obamacare. "I want to get to where we promised."

Rep. Mo Brooks (R-Ala.), who's also had separate conversations with the administration, said federal waivers would be susceptible to changes by future presidential administrations. The changes, he said, "may be sufficient to persuade some people to accept an otherwise bad piece of legislation but in and of itself is insufficient to persuade me."

The bottom line is, it should be up to the consumer, not the state, and not the federal government, to decide what kind of insurance policy he wants and what kind of coverage he desires.  Until choice is returned to the consumer, premiums will remain high.  Any temporary "fixes" that rely on having a Republican president for the rest of our lives aren't worth the paper they're written on.

Ed Straker is the senior writer at