GOP health proposal could lead to higher premiums for sick people

Greg Nash

New discussions around the White House’s ObamaCare repeal effort could lead to more expensive health insurance for people with pre-existing conditions.

While Republicans have indicated they would keep ObamaCare’s provision that requires insurers to cover people with pre-existing conditions, a new proposal from the White House could lead to sicker people paying more for coverage. 

Vice President Mike Pence presented an offer to the conservative House Freedom Caucus on Monday that would allow states to apply for waivers to repeal two ObamaCare regulations: essential health benefits, which mandate which services insurers must cover; and “community rating,” which requires insurers to charge sick people the same rate as healthy people if they’re the same age.

{mosads}Under this proposal, expected to be released as early as Tuesday night, people with pre-existing conditions could still get healthcare — but insurers might be able to charge them much more than they’re currently paying under ObamaCare. 

Rep. Mark Meadows (R-N.C.), chairman of the Freedom Caucus, said Monday night the “backstop” for people with pre-existing conditions priced out of coverage would be high risk pools, which operate by separating the seriously ill out of the insurance market. 

This would lead to lower premiums for everyone else, he argues. 

“The fundamental idea is that marginally sick people would pay the risk associated with their coverage,” Meadows told reporters Monday night.

“Those that have premiums that would be driven up because of catastrophic illness or long-term illness, we’ve been dealing with that for a long time with high-risk pools.” 

Still, some experts say allowing states to opt out of the community rating provision would undermine protections for people with pre-existing conditions. 

“Allowing insurers to price people with pre-existing conditions out of the market is eliminating pre-existing condition protection,” tweeted Toper Spiro, vice president for health policy at the Center for American Progress. 

Larry Levitt, president of the Kaiser Family Foundation, tweeted: “If there is guaranteed access to insurance without community rating, protections for people with pre-existing conditions are illusory.” 

Others have highlighted past statements made by Pence and Trump that people with pre-existing conditions shouldn’t be charged more for coverage. 

“We will protect Americans with pre-existing conditions so that they are not charged more or denied coverage, just because they have been sick, as long as they have paid their premiums consistently,” Pence said in November.

Allowing states to opt out of essential health benefits could also hurt sicker people because while they can still buy a plan, it may not cover some of the services they need such as prescription drugs or hospitalization. They might have to pay extra for those services. 

The changes will likely be made to the original repeal bill introduced earlier this year, the American Health Care Act. It was pulled from the floor last month because it lacked the support needed to pass.

Any changes to the bill need to be able to attract conservatives and moderates, who balked at the initial legislation. 

It could also face a tough path in the Senate, where almost every Republican needs to support it to pass. 

Tags Mike Pence

Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

See all Hill.TV See all Video

Most Popular

Load more


See all Video