An exemption for Congress roils Republicans’ latest health care effort

Wednesday night, text leaked of a new Republican amendment to the party’s health care bill, the American Health Care Act, which was part of an ongoing effort to revive the bill in the House.

The amendment would allow states to opt out of some politically popular Obamacare provisions, like the requirement to charge sick people the same prices as healthy people, or to cover a core set of benefits.

Health law expert Tim Jost called me when he noticed something surprising on the sixth page of the amendment: an exemption for the health insurance of legislators and their staff. This means that members of Congress and their aides would be guaranteed access to Obamacare provisions that constituents could lose.

I wrote about it. It caused a stir. Twelve hours later, Republican legislators appear to be split — but not over the exemption policy itself. Instead, they have disputed whether it even exists.

This morning alone, legislators have claimed that the exemption never existed, that it does exist and was inserted by senators, and that it used to exist but has been removed.

The current frenzy suggests that the Republican health care process is not one where leaders are fully informed of the latest developments. Instead, the debate over the congressional exemption suggests that legislators have very different ideas about what is in their latest amendment.

It has now been confirmed to me by two health policy experts as well as the office of Rep. Tom MacArthur (R-NJ), who offered the amendment, that the paragraph beginning on page six, line 17 of this document would exempt legislators and their staff — who are required to purchase Obamacare coverage — from the amendment’s waivers.

The exemption is “explicit and purposeful if you follow the cross-references,” says Nicholas Bagley, a health law expert at the University of Michigan. “It’s not hidden, it just doesn’t leap off the page unless you do some cross-referencing with the Affordable Care Act.”

You can read a bit about how the exemption works in this story.

Rep. Mark Meadows (R-NC), who chairs the House Freedom Caucus, kicked off the morning by saying that the exemption didn’t exist.

This explanation doesn’t make much sense, however, because the Affordable Care Act explicitly goes out of its way to define the District of Columbia as a state.

And a few hours later, Meadows seemed to acknowledge the existence of the exemption by saying he was “100 percent” certain it would be removed from the amendment.

Meanwhile, other sources told Politico’s Rachael Bade that the exemption did exist and that it was inserted at the insistence of Republican senators.

Elsewhere, Rep. David Brat (R-VA) was telling other reporters that the exemption used to exist but has already been “fixed.”

My colleague Tara Golshan was among the reporters Brat spoke with, and she jotted down a few more of his remarks.

“We fixed that,” he said. “I don’t want to go into the details. It’s fixed. Guaranteed. I never lie. We already had a fix — just no one knew about it. We just haven’t messaged on it yet.”

Right now, it seems like Republican legislators acknowledge the exemption exists but haven’t been clear on why it was inserted into the bill in the first place. They are now working to remove it. We’ll keep you updated on what happens next.