By Pete Zamplas- Freedom Caucus Chairman U.S. Rep. Mark Meadows sees the health care stalemate unlocked by Easter, easing off from a demand for a full Obamacare repeal that made national waves after he stood toe to toe with President Donald Trump.
But the local congressman still firmly seeks to undo two more regulations in order to further lower insurance premiums and boost care quality. “I’m optimistic we’ll find some kind of resolution, in the coming days,” third-term Rep. Meadows told The Tribune Monday, while driving from the 11th House District in western North Carolina back to the nation’s capital.
That night, the UNC Tar Heels won the national basketball title, while Meadows conferred with Vice-president Mike Pence.
Meadows remains a Trump supporter. “He’s done more in 65 days than any president in modern history,” with executive orders to roll back regulations to try to spur business growth, Meadows said March 26 as special guest on ABC’s This Week with George Stephanopoulos.
He praised the “master negotiator” as one to be “admired for his negotiating prowess. He is extremely engaging. If a deal is met, it’s because of the president’s personal involvement.”
He calls Trump’s mediation in legislation as “unparalleled in the history of our country. To engage a number of members is indicative of a president who wants to solve problems.”
As for style, true to his sound-bite image, Trump came across to Meadows as wanting to hear succinct arguments with specifics and conclusions. “The more specific I was, the more receptive he was. It worked best keeping it brief and specific.” He said there was “not contentious, but a very rigorous debate.”
Republicans hope to secure a legislative victory, in their arena. But they likely must appease conservatives some more. Meadows cautioned against rushing too much, especially the first time around on health care, but also on giving up on finding consensus.
Many see the Trump Administration as too eager for its first policy win. “We hope to reach agreements in the coming days,” Meadows said of the proposed American Health Care Act of 2017 (H.R. 1628).
“Negotiations are still ongoing,” he said, and meanwhile he is also in the midst of efforts to tackle the taxes issue.
“I’ve talked to the White House numerous times in the last 72 hours,” he said Monday. “We’re trying to find some area of compromise, with the more moderate (“Tuesday Group” of about 50) in our (GOP House) conference.”
Speaker Paul Ryan shelved the bill on March 24, the deadline President Trump set for a vote to force congressmen to go on the record. Ryan held off, as there seemed not enough votes from GOP colleagues to pass it.
There was movement even then. The House Freedom Caucus (HFC), which had enough votes to reject a bill not strong enough in its view, pressed for two concessions. Now, the two GOP groups are getting closer this week. Moderates met with executive officials Monday in the White House, and are reportedly warming to letting states opt out of some health care mandates such as with a waiver process.
There was verbal agreement on allowing states to decide whether to scrap requirement of insurers as a basis in all policies covering ten “essential” services. Democrats fear those coverages will be discarded if not mandated, or insurers will offset pricier plans with skimpy insufficient ones. The areas of coverage include prescription drugs, doctor visits, lab tests, emergency visits and hospitalization which are useful to most people.
But four others are specialized for some, such as pediatrics, maternity care, substance abuse and mental health treatment. By forcing them into everyone’s policies, it spreads out the cost but boosts it for those not needing such services.
Meadows said Obama’s one-size-fits-all approach thus jacks up costs for unneeded coverages, rather than allowing greater choice of which doctor to see and to buy insurance only for what is truly needed and affordable.
He seeks to undo the additional hamper on businesses that wish to employ more than 50 people (the threshold in most states), but do not do so since, if they do, they are then required to insure all of their workers with pricier policies.
The stumbling block is the concession not yet attained, and thus to get the HFC on board. It is to ax the “continuous-coverage” element of community health ratings. These now forbid insurers from charging higher premiums based on one’s health history or gender, thereby punishing healthier people. Meadows’ press secretary Ben Williamson notes it now forces offering “certain policies in a territory, at the same price level without regard to health status. Premiums go up,” for most (healthier) people, more so if they must get pricier comprehensive coverage.
Meadows stated the new health care program needs to be a free “market-driven approach, that brings down costs and provides more choices for the American people.” He added, “some of the provisions in here do not lower health care costs enough. Certainly, not for my constituents. Some have seen their health care premiums go up 30, 35 percent then another 30 percent in North Carolina this year. When you look at that, you see that Obamacare is not sustainable.”
Trump, Ryan and Meadows are singled out in media as the three main players in GOP health care legislation. HFC with 30 newer members is a pivotal voting bloc. Meadows has led the HFC since winning its chairmanship in December. This group’s numbers helped give the GOP a House majority — fractured though it is, at times. HFC members got elected as anti-establishment Republicans, with staunch Tea Party support.
They stuck to their guns prompting a brief government shutdown in 2013, as leverage to force a tighter budget. They even led the ouster of John Boehner as Speaker in favor of the more conservative Ryan, and replacement of Eric Cantor with Kevin McCarthy (R-Calif.) as House majority leader.
Meadows said the House should stay in session and delay Easter recess until reaching a deal to both repeal and replace the Patient Protection and Affordable Health Care Act (“Obamacare”) of 2010 with what is being called Trumpcare and Ryancare. McCarthy, who has visited Hendersonville, also calls for action soon.
The GOP plan gets rid of the abhorred penalty fees for not getting insured. But Meadow is among conservatives labeling it Obamcare Lite, for retaining too many systematic flaws. Many are leery of retaining federal aid to some insured people; only five percent get that aid in Henderson County. Distribution would change largely to tax credits.
Meadows calls for an “adequate safety net for those most vulnerable.” This includes enabling those with pre-existing conditions to get insured (ideally at reasonable/affordable rates though neither party has instilled price caps), helping lower-income families with aid or at least tax breaks, and enabling youth to stay on their parents’ plans through age 26.
A basic barometer is will it “lower premiums significantly enough, to make a real difference for people that are struggling to pay for health care? I think we have that at the core of where we are.”
Meadows and others of HFC went to Oz — the Oval Office (not Trump Tower) — behind the curtain to see the Wizard of the Deal in action first-hand March 23. This was hours ahead of the planned vote that Thursday night, which was then put off to the next day then called off.
“We both agree we need to cover more people, and (in regulations) do less to hurt mom and pop stores on Main Street,” Meadows said of Trump.
Further, “I let him know this is not about me or the Freedom Caucus. It’s about the American people. It’s about him being able to put together a deal.” Trump initially pressured the HFC to give in, to seal the deal. HFC balked, but Meadows said offered a pending compromise of two more regulatory reversals. Ryan obliged on one, but not yet the other.
President Trump “wants to give in on the other point,” but not lose too much support among GOP moderates and any Democrats needed, Meadows sensed from their discussions.
“His concern is, can he get it through the House and Senate. We’re not at odds over policy — but rather with what some of his leadership staff tells him is (legislatively) possible and not possible.”
Declaring health care reform dead is “like saying (Super Bowl winning quarterback) Tom Brady lost at halftime,” Meadows said on ABC about the delay on a House vote.
He anticipates the GOP will “get this over the finish line” in the House, after that the more liberal Senate bumps it to conference committee to hammer out a final compromised version. The House now “may be in overtime,” he said in further sports analogy.
“At the end of the day, the most valuable player will be President Trump. Because he will deliver. He’s committed to the American people … to repealing Obamacare, and replacing it with a system that works for American families. I look forward to working with him to do just that.”
The president, after tweeting angrily against HFC members, by Sunday reversed his tone toward conciliation, or at least optimism that he gets his way. He vowed GOP “love and strength” will unify for a health care bill.
Populist President Trump varies across the political spectrum. He is emerging as more moderate and compromising on some budgetary issues than the HFC. Yet true to his Tea Party backing, he is more hawkish on immigration than GOP moderates, still wants to wall off much of the Mexican border, perhaps even more so than conservative-moderate Republicans led by Speaker Ryan.
Ryan (R-Wisc.), the GOP V.P. candidate in 2012, has taken heat for leading the Trumpcare charge before votes were in place. Meadows said Ryan has worked diligently, and is not for replacing him as Speaker.
But Meadows cautions “we probably need more time to read these bills, and really debate them before they’re rolled out and presented as a binary choice — this way, or no way.” Days earlier, he told the media following him through congressional hallways that “if we’re not sure of those answers, we need to read the bill and understand the bill fully before we take a vote on it.”
He applauds how Ryan publicly admitted the bill is “fundamentally-flawed,” and he wants to “improve” and “refine it.” This opens the dam for more compromise and consensus. Meadows said he understands the concerns of GOP members both “conservative or moderate. Addressing those concerns is to be applauded. Especially when at the end of the day, we have a much better bill than was rolled out. It’s not perfect. But it’s much better than it was three weeks ago.”
HFC is depicted as unbending, and indeed has been resolute on many issues. But Meadows points out he has made a huge concession by abandoning the caucus’ earlier stance of a full repeal of Obamacare. Initially after the stalemate March 24, he stated “I promised the people of North Carolina’s 11th District that I would fight for a full repeal of the Affordable Care Act.” But he has since eased off of that insistence, though “many of us ran on full repeal” as he notes.
“We’ve gone from the ideological view for a full appeal, to more pragmatic — what can we accomplish in the Senate, and get for people to lower insurance premiums,” he told The Tribune. “The original (GOP) bill repealed two of the 12 mandates in Obamacare. In the spirit of compromise, we just asked for an additional two — to make a total of four insurance regulations to be repealed. These two have the most impact, to drive premiums down.”
In compromise, for now at least, he is easing the push to lift limits on where insurance companies can operate to boost competition and pricing across state lines.
Meadows and U.S. Sen. Ted Cruz (R-Tex.) co-wrote an essay on reforms, in mid-March. They call for a “true 50-state marketplace” to raise competition and in theory lower prices. They stated that “small businesses should be allowed to pool together in association plans, to get better rates for their employees.”
Malpractice reform to lessen frivolous lawsuits is another goal. These could be introduced in follow-up bills, after securing other changes in the current proposal.
Conservatives are upset that several proposed changes are tentative since they are put off to the next (2018) congressional election, or 2020 such as Medicaid freezing. Thus Democrats could stop changes from happening should they control in Congress or the White House. Medicaid funding gets switched to more selective per-capita block grants in the GOP plan.
Meadows understands moderates’ concern of fewer people being insured. In response, conservatives gave up accelerated phaseout of Medicaid expansion by two years. Even a handful of GOP senators opposed that, rendering it a hindrance to passing the overall bill.
Democrats as usual are touting more liberal perspectives, and get much public backing in the left-leaning national media. They oppose a total repeal of Obamacare that the Freedom Caucus insists on. “If they would denounce repeal…then we’ll work with them on improving it,” Senate Minority Leader Chuck Schumer (D-N.Y.) told the media.
Meadows questions Democrats’ true willingness for bi-partisan action, rather than partisan obstruction to stymie Trump and the GOP. He told ABC “on this Obamacare repeal and replacement, before he (Schumer) saw a plan he said he was against it.”
Trumpcare is ushered in as a reconciliation bill, under power a Democrat-led Congress created in 1974 to expedite certain tax, spending and debt limit legislation. This limits debate to 20 hours in the Senate, preventing a lengthy filibuster obstruction there. But it also limits scope of policy change.
Passing health care reform in turn makes it much more doable to reform taxes — also on the front burner — such as by eliminating tax health care penalties for not being covered and stipulating revenue sources.