Yesterday, the House GOP passed the AHCA, their long awaited repeal and replacement piece of healthcare legislation.  Ever since the original bill was pulled on the 25th of March, House GOP leadership and the White House have been working on inserting language into the bill to get wayward members on board.

Well, by allowing states to opt out of covering preexisting conditions and mandating 10 essential services be covered, the Freedom Caucus came on-board.  To get moderates on board the bill mandated states that opt out of the ACA’s preexisting conditions requirement must set up high risk pools.

Moderates balked at the idea.  As a result, to assuage moderate member’s concerns the bill created an $8 billion federal fund to help states set up their high risk pools.  By a narrow 217-213 margin, the House GOP passed their modified bill.

As happy as I am personally to see the ACA go the way of the dinosaur I am personally disappointed to see the GOP ignore the needs of the most vulnerable.  By allowing states to opt out of the preexisting conditions requirement the bill allows states to ignore those who need the most help.

When looked at in its entirety, the bill is mostly a win for conservative causes.  The bill repeals the Individual Mandate, allows states to decide whether or not to keep Medicaid Expansion (but the state will have to pay for it in two years) and promotes lower premiums and choice.  Of course, the grab bag of goodies put into the law are not its finest points.

Still, if I were a member of Congress, and I am not, I would have voted no on this legislation.  Not because I am not a conservative, nor a fan of Obamacare, but rather because the law leaves millions of low income Americans and hundreds of thousands more with preexisting conditions in limbo.  A fund of eight billion dollars is hardly enough to cover in perpetuity millions of high-risk Americans.

With the bill passed through the House it now heads to the Senate where it is sure to be changed.  Republicans can only lose two votes to pass a repeal via the Reconciliation process.  Considering this, preexisting conditions might work there way back into the bill and force a Senate/House showdown.

I would find myself siding with the Senate in this case.  Survey after survey has shown while Americans are not willing to pay more via the Individual Mandate, the 10 Essential Services, or what have you they are willing to  pay a bit more to cover those with preexisting conditions.

Republicans are right to worry about the cost of premiums.  Health Insurance continues to cost more and burdensome regulations that limit competition or penalize individuals for not carrying insurance (creating a perverse incentive) do not help.  Many aspects of the law would eliminate regulations, lower cost and increase competition.

But, here is the rub, and this is where ideology runs smack dab into practicality.  Many individuals with preexisting conditions lack the ability to even gain access to insurance.  By ensuring insurance companies cannot deny them coverage based on this fact alone does not guarantee they will acquire insurance.  But, it does ensure they have the chance to access insurance.  That is missing in the bill.

Unfortunately or fortunately, depending on how you look at it, coverage for preexisting conditions has become the main dividing line in the GOP Caucus over the AHCA.  Moderates wanted assurances the law would ensure they could not be discriminated against and could access coverage while conservatives hated the requirement because it inevitably drove up costs.  Of course, conservatives didn’t seem to have a problem with allowing insurance companies to charge individuals an additional 30 percent fee on their premiums if they go without coverage for 63 days or more.

But I digress, in my mind and many moderate Republican lawmaker’s views the law does not protect individuals with preexisting conditions.  Personal note here, but I have a preexisting condition, and while it has somewhat impaired me, I am able to function well in society.  But millions of Americans cannot without costly drugs or medical care.  These are the individuals the AHCA should continue to protect and it does not despite close to 90 percent of Americans agreeing to pay a little more to cover those with preexisting conditions.  Workarounds to help them are great and all, but in the end the law does not protect the most vulnerable among us.  And that is why I oppose this piece of legislation despite all the good it does.