As I wrote in my headline yesterday, the House punted the vote on AHCA to Friday. This should not have come as a surprise because the vote tally was way short, and the ultra-conservative House Freedom Caucus refused to back the bill. the HFC has anywhere from 30-40 members and if within the caucus 80% vote a certain way, then the full caucus will vote that way. At this point, the HFC is leaning no.
This is a strict power play by the HFC. The group is demanding extreme rollbacks of provisions, popular provisions of ACA. For example, the group is demanding that "essential health benefits" are no longer required as part of all insurance plans. The belief is that requiring these 10 coverage areas in all plans drives up premiums. This may be partially true. My counter-argument is that over the long-term, the benefits of preventative, mental health and other coverages would lead to less overall cost, which tend to fall more on taxpayer shoulders instead of the individual. (Note: I am not talking a position on the morality of coverage in this post),
At this point, there is a battle between HFC & Trump, and whoever wins will determine the fate of the vote on Friday. If the HFC wins, then the AHCA will drastically strip provisions from Obamacare and the House will pass the AHCA. If Trump wins, it will be because he held the line and didn't give in to the most hard-line demands. It appears, at least tonight, that Trump was leaning towards stripping "essential health benefits" but would not compromise preclusion of pre-existing conditions and the current age of 26 to remain on a parents plan.
Side note - if the 21-26 age group were required to own individual policies, it would add more young, healthy people to insurance pools which would offset high-risk people and theoretically drive down costs.
We'll see what happens tomorrow. This bill not passing would be a massive embarassment to Trump and potentially be the end of the Paul Ryan Speakership. Additionally, the rest of Trump's "agenda" including tax cuts, infrastructure spending would be in serious doubt.