The revised Republican ObamaCare replacement bill is testing the party's pledge to preserve protections for people with pre-existing health conditions.
House Republicans' own website states that people should "never" be charged more for having a pre-existing condition, but the revised bill would allow just that in states that are granted a waiver from some of ObamaCare’s protections.
An amendment from Rep. Tom MacArthur (R-N.J.) would allow states to apply for waivers to what is known as community rating, which prevents insurers from charging higher premiums to different people within a certain territory, regardless of their health status. Without that protection, insurers could go back to charging people with pre-existing conditions exorbitantly high premiums, which could put coverage out of reach for many.
Under the amendment, people would still be protected if they maintain “continuous coverage,” meaning they do not have a gap in coverage. And in order to receive the waivers, states would have to set up high-risk pools to help provide coverage for sick people.
Critics of the high-risk pools say they were tried before ObamaCare was enacted and were ineffective.
The possibility that some states could go back to the days of insurers charging sick people high rates is testing Republican vows.
President Trump had promised to keep ObamaCare protections for people with pre-existing conditions. “It happens to be one of the strongest assets,” Trump told CBS’s “60 Minutes” shortly after the election.
Some moderate Republican lawmakers are opposing the new healthcare bill on the grounds that it breaks the pledge on pre-existing conditions.
Asked about the pledge on the House Republican website, Rep. Leonard Lance (R-N.J.), who opposes the bill, told MSNBC, “I do not think that the current configuration of the law is consistent with that, and that’s why I’m voting as I’m voting.”
“It would cost people more than it’s costing them now, people who are already sick, and that’s not going to help those people,” Rep. Dan Donovan (R-N.Y.), another moderate “no” vote, said on CNN of the revised bill.
Many Republican lawmakers also pledged not to let people with pre-existing conditions get charged more. However, some of those lawmakers are now supporting the amendment that would allow states to repeal the ObamaCare protection.
“We’re not going back to the days when they could underwrite you, say, ‘Oh, yeah, we’ll cover you. It’ll just be so expensive you can’t afford it,’ ” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) told a town hall in his district earlier this month. “That is not a plan I can support.”
Asked about the comments, an Energy and Commerce aide pointed to $130 billion in the bill in funding for high-risk pools and similar mechanisms to help sick people get coverage.
“The MacArthur amendment preserves important protections for individuals with pre-existing conditions while also giving states flexibility to design insurance programs that work for their unique populations,” the aide said. “The $130 billion in funding for states to build risk-sharing programs will ensure that both our promises of protecting patients and lowering premiums are kept.”
Rep. Patrick McHenry (R-N.C.), the chief deputy whip, earlier this month had warned that the demand from the Freedom Caucus for states to get waivers for community rating and other ObamaCare protections would be “a bridge too far for our members.”
McHenry spoke in personal terms about his family medical history to tout the importance of the ObamaCare protections, contained in Title I of the law.
“If you look at the key provisions of Title I, it affects a cross section of our conference based off of their experience and the stories they know from their constituents and their understanding of policy,” McHenry said then.
McHenry is now whipping his colleagues to support the measure.
Larry Levitt, a health policy expert at the Kaiser Family Foundation, said the revised GOP bill “effectively eliminates guaranteed access to insurance for people with pre-existing conditions.”
While people who maintained continuous coverage would still be protected, Levitt said some people have gaps in coverage because they cannot afford it and would not be protected from potentially “astronomical” premiums.
The $130 billion for programs like high-risk pools “would help,” Levitt said, “but none would provide guaranteed access to people with pre-existing conditions.”
The American Medical Association, in a letter opposing the revised bill, warned that allowing insurers to charge much higher rates to sick people would make pre-existing condition protections “illusory.”
Some moderate Republicans are struggling with the changes to pre-existing condition rules after having faced rowdy town halls this month where those protections were front and center.
“I made it very clear ... to my constituents that I’m going to protect pre-existing conditions, and so this is a fairly complicated proposal, so I’ve really got to review it,” said Rep. Mike Coffman (R-Colo.).