“Figure out a way to change the state that you live in.” That was the controversial advice White House budget director Mick Mulvaney offered to those worried about a proposal that would allow states to repeal required essential health benefits in health-insurance plans. That provision didn’t quite make it into the last round of the Republicans’ effort to repeal and replace Obamacare, and Mulvaney later clarified that he was urging citizens to persuade their legislators to enact changes where they lived, not encouraging them to move. But the soundbite, endlessly replayed on cable news, became a rallying point for the plan’s opponents. If Americans want their insurance to cover things like maternity care, hospital stays, or mental health under the future written by the American Health Care Act, they warned, they might soon have to pack up and move to another state.
The last round of Republican negotiations on the AHCA died last month in the House, driven by defections both among the ultra-conservative Freedom Caucus, who balked at the elements of Obamacare individual cost controls that it maintained, and also by moderates, who thought that the controls the law cut were too draconian, especially for their working-class base. But President Trump and congressional Republicans have renewed negotiations on the AHCA in recent weeks, hoping to mollify the rebellious Freedom Caucus with more conservative additions to the bill. A new proposed amendment from Rep. Tom MacArthur might accomplish just that, but in the process might actually be the final nail in the bill’s second coffin.