On March 24, Speaker Paul Ryan declared he would be pulling the American Health Care Act from a House vote that, to Republicans' dismay, lacked the support to pass. Despite GOP control of both congressional chambers, the party remained divided on how much to change Obamacare, and a straight repeal risked too much market and political chaos. Millions of Americans insured under the Affordable Care Act breathed an enormous sigh of relief. Ryan conceded, "We're going to be living with Obamacare for the foreseeable future." Then, two representatives — Tom MacArthur and Mark Meadows — got together and came up with the MacArthur amendment. Meadows and MacArthur's plan struck a devil's deal between ultra-conservatives and moderate Republicans, and it's the reason the AHCA made it through the House and now awaits the Senate vote.
The key provision in the MacArthur amendment gives states the option to "opt out" of Medicaid expansion, which frees them to offer insurance plans not subject to mandated coverage of pre-existing conditions. In other words, MacArthur and Meadows — who are both millionaires, by the way — wanted to make sure that insurance companies were protected from sick (read: expensive) customers. That's quite an approach to health care, honestly, but it may help to remember that MacArthur's partner in crime here, Meadows, is chairman of the House Freedom Caucus.
Can we talk about them for a second? I don't think they get quite the press they deserve.
The House Freedom Caucus comes forged from the ideology of the Tea Party movement, which saw a wave of candidates elected to Congress who were almost as opposed to "regular" Republicans as the Democrats. In the House, a group of nine of these "true" conservatives decided in 2015 that they would form their own lobbying posse, and thus was born the Freedom Caucus. The group now has 36 confirmed members.
I say posse for a reason. This is a group of almost all-male, nearly all-white reps who, if they had their way, would scrap Obamacare in toto and move to a straight free-market insurance model. (The Freedom Caucus has one female and one minority member, each.) There's a kind of yee-haw, I'm-a-tough-guy feel to the bunch, exemplified best by their Senate pal, Ted Cruz.
The Freedom Caucus is responsible for forcing former Speaker John Boehner's retirement, and they're behind multiple calls for government shutdowns if their demands are not met. Those ultimatums include cutting off funding for Planned Parenthood and drastically cutting government spending altogether. (They will make exceptions for the military.) Their renowned refusal to negotiate has earned them the nickname "bomb thrower caucus."
And here's the real gut-punch of the Freedom Caucus: Any Republican wanting to pass legislation has to do business with these guys. With a majority of 241 seats to the Democrats' 194, Republicans cannot afford to lose the votes of the entire posse, especially since it's rumored the group boasts more than just the 36 confirmed members.
So Rep. MacArthur decided business with them he would do. MacArthur represents New Jersey, and was elected leader of another Republican House caucus, the Tuesday Group. (I think of Mr. Rogers every single time I read, write, or think "Tuesday Group." Now you can, too.) The Tuesday Group (cardigans! trolleys!) is a centrist body of about 170 representatives.
MacArthur met with Meadows, and the two came up with the MacArthur Amendment, which as mentioned above, relieves insurance companies of the burden of providing coverage for anyone who may, you know, really need it. Since the amendment appeased the Freedom Caucus (by moving more toward a free market), Ryan had the votes he needed. And so passed the AHCA, celebrated by a massive white dude press conference and, allegedly, truckloads of beer.
In fairness to the Tuesday Group (and Mr. Rogers!), MacArthur is taking some serious heat for his wheeling and dealing with the Freedom Caucus. "You are going to make us lose our majority," seethed a fellow representative, according to Politico. Some of the Tuesday Group members are considering removing MacArthur from his leadership position. Many of them were angry about the loosened protection for people with pre-existing conditions. Twenty moderate Republicans ended up voting "no" on the AHCA, purportedly because of the changes made by the Freedom Caucus.
MacArthur also just faced the music at a town hall with his constituents, most of whom seem incredibly angry at his role in passing the AHCA. For his own part, MacArthur really doesn't seem all that aware of how this legislation will hurt millions of Americans, and in particular, women. It makes one wonder: How might things have been different if women — seriously, even one woman — were involved in the Republican negotiations about health care?
We'll never know. Meadows and MacArthur passed their AHCA amendment, and now the legislation will be taken up by the Senate. Thankfully, the upper chamber has demonstrated some of that maturity it's reputed to have, with members indicating they're not big fans of this proposal.
So, here's a suggestion for the Senate: Make sure there's diverse representation present when you sit down to craft your own version of the AHCA.