Donald Trump is pushing again for his repeal of the Affordable Care Act. The hope is that they will be able to get a repeal through congress and on the books before the media starts reporting on the first 100 days of his administration. The reason that the bill failed the first time bears repeating, and some of the things to watch for merit mention.

The repeal of the ACA did not pass the first time through the House. In fact, to save themselves the embarrassment, Speaker Paul Ryan pulled the bill before a vote occurred. There were two main factions within the GOP that failed to get on board. First, the Republican congressmen in swing districts found themselves unable or unwilling to vote for the bill that would have ripped healthcare away from so many in their district and raised costs to drastically on the elderly.

Republican U.S. presidential candidate Donald Trump speaks at a campaign rally in Eugene Oregon
Republican U.S. presidential candidate Donald Trump speaks at a campaign rally in Eugene, Oregon, U.S. on May 6, 2016. REUTERS/Jim Urquhart/File Photo

The second group of GOP congressmen that refused to get behind the bill was the House Freedom Caucus. Republican leadership found itself again on the business end of the staunchly conservative group who held no qualms about saying no. It is important to remember that this group, who is large enough to be pivotal to any vote the GOP wants to pass, did not support the bill because it did not take enough away from people. It wasn’t a draconian enough measure.

So, as the new bill comes to bear look for things like measures to cut protection for pre-existing conditions, and look for it to also raise the costs to significant sections of the populace. If it looks enough like harsh austerity, the Freedom Caucus may well get on board.

As a side note, there was a recent development in Alaska, where the state dealt with climbing premiums. The state was facing outlier premium hikes of over 40%. The state government figured out a way to prevent that and cut their premium increase to 7% by backstopping the possible losses insurance companies could absorb from high cost customers. In this way, Alaska put $55 million into a reinsurance fund, and as a result, the insurance agencies were able to control premium increases in a big way. When premiums increased so little, federal subsidies actually fell by $56 million. So, now Alaska is actually seeking to have the federal government reimburse them for their expense. It seems like it’s possible to make some tweaks, provide healthcare access, and fix the Affordable Care Act exchanges.