The “MacArthur Amendment” to the American Health Care Act is responsive to what House Republicans have learned about the priorities different factions within their coalition. The Freedom Caucus prioritizes deregulation of the individual insurance market to lower costs and constrain the federal role. The moderates prioritize coverage levels and protection for people with pre-existing conditions. Rather than try to arrive at a single overall balance, the approach Republicans are now pursuing allows state governments to have relief from the rules that drive up costs and make their insurance markets unsustainable if they propose alternative rules that would still protect people with pre-existing conditions and make coverage accessible.

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