The biggest political news coming out of the House's passage of the American Health Care Act (AHCA) is that most members of the Freedom Caucus voted for it. This is legislation that extends age-adjusted, refundable tax credits to all Americans without access to employer coverage, much of which will count as new spending in the federal budget. The bill also largely retains the Affordable Care Act's (ACA) insurance regulations in the individual insurance market, despite what is being said in the press. There was a time when Freedom Caucus members would never have voted for such legislation. It seems the blowback on the caucus following the failure to pass the bill in March had a major effect on their outlook.
Much has been made of the MacArthur-Meadows amendment allowing states to opt out of the community-rating rules of the ACA. Some conservatives seem to think this amendment completely changes how the bill will work in practice. It won't. For starters, the odds of this provision surviving in the Senate are low. The provision almost certainly violates the Byrd Rule -- the requirement in the Senate that provisions of reconciliation bills, such as the AHCA, must be budget-related in order to be protected from a Senate filibuster -- because it is aimed at state regulation of insurance and does not directly alter federal spending or revenue provisions. There probably aren't 51 votes in the Senate for the MacArthur-Meadows amendment, much less 60.
