It's become a given in American politics that when the House Freedom Caucus starts throwing its weight around, it's not going to end well. It's been the driver behind what's different in the new GOP health care bill, and it doesn't look good for those who aren't healthy and wealthy. UPDATE: The AHCA has officially passed the House with a majority of votes, 217 to 213.
There have been two main changes to the bill since it first failed in the House. The House Freedom Caucus refusing to support the GOP's first stab at a new bill was one of the major reasons why the party couldn't initially gather enough votes to send it over to the Senate, so this revised version was tailored to fit the group's concerns. The bill, in its current form, contains an amendment put forward by New Jersey Rep. Tom MacArthur that caters to their demands — namely, by allowing states to apply for waivers that would let them charge older customers much more than younger ones.
The MacArthur-Meadows amendment, as it's known, would also let states determine for themselves which "basic benefits" must be included in a plan, and it could force sick customers to pay much higher costs if they let their coverage lapse for more than two months. The contents of this amendment convinced most of the Freedom Caucus, but it left many others with doubts about how people with pre-existing conditions would fare.
This is when Michigan Rep. Fred Upton stepped in with a proposal to help cover people with pre-existing conditions. His proposal, though, is fairly minimal considering that it's meant to cover a nation of over 300 million people. It only adds $8 billion to the pool of money meant to help states cover those with higher health care costs, and Democrats have had some pretty strong words on the subject.
"The proposed Upton amendment is like administering cough medicine to someone with stage-four cancer," said Sen. Chuck Schumer in a statement. "This Republican amendment leaves Americans with pre-existing conditions as vulnerable as they were before under this bill."
Rep. Nancy Pelosi of California, the top Democrat in the House, also said that she thought it was far too little to cover what would be necessary. "It's a joke. It's a very sad, deadly joke," she said.
Besides that, this is still the same Obamacare repeal that would likely leave 24 million additional people uninsured by 2026 and gut provisions for people who are older, lower income, and living in higher cost areas. Low-income women are some of the worse off in the new scenario, with the defunding of Planned Parenthood and the fact that Medicaid would not be required to cover basic benefits like maternity care or contraceptives after 2020.
Republicans in the House expect the bill to pass, but it will then face new resistance in the Senate. This might look like a legislative victory for President Trump, but he's far from out of the woods yet.