While House Republicans are celebrating the passage of the American Health Care Act, many are criticizing the bill, saying a provision allowing states to waive certain requirements could leave people with pre-existing conditions priced out of coverage.
U.S. Rep. Mark Meadows, who helped the amended bill gain enough support to pass the House 217-213, says recent amendments provide protections for people with pre-existing conditions.
“I think probably the biggest confusion is really a narrative that pre-existing conditions won’t be covered because of allowing people to rate insurance based on health conditions,” he said.
“If you’re one of the 176 million people” who get insurance coverage in a group plan from their employers, or are on Medicare or Medicaid, he said, there will be no changes in coverage for pre-existing conditions.
Who could be affected are the 9.3 million people in the U.S. who get coverage through the Obamacare exchange or the individual market, he said.
Meadows released a statement shortly after the House voted on the bill, saying the process was never about getting a win for Republicans or the Freedom Caucus, but “it’s about getting a win for the countless Americans who are being crushed by the broken system of Obamacare.”
In the statement, he said that from the earliest stages of the discussion, his goals were to bring down insurance premiums and to protect people with pre-existing conditions, that there is still work to be done and that he looks forward to working with the Senate to improve the bill.
Just as he was instrumental in the House passing the amended bill, Meadows was instrumental in the failure of the bill’s initial form. The biggest issue he had was premiums, he said, as most people in his district would have seen a 15- to 29-percent increase in the short term.
The new version of the bill, provided North Carolina takes a waiver, he said, “will lower premiums for most of the people that I serve around 40 percent.”
Even if North Carolina doesn’t take the waiver, he expects premiums to drop around 22 percent.
Jaclyn Kigler, managing attorney for Pisgah Legal Services, said that PLS is very concerned about the bill as it stands now, but stressed that the Afordable Care Act is still the law and people can still get health insurance, with open enrollment slated to start in November.
“We’re watching it closely,” she said. PLS is hopeful that many of the protections for low-income people and people with pre-existing conditions will be built back into any bill that comes out of the Senate.
In terms of pre-existing conditions, she said, the proposal that passed the House essentially allows states to request a waiver to scale back certain essential benefits required under the ACA, known as Obamacare.
But the protections for people with pre-existing conditions in the bill are three-fold, Meadows explained, through three amendments to the AHCA which take measures to prohibit premium increases for major diagnoses or chronic conditions, create a federal high-risk pool and add more money for those high-risk pools.
Meadows worked with New Jersey Rep. Tom MacArthur on an amendment that made several changes to the initial AHCA. States would be allowed to obtain waivers from certain federal standards like essential health benefits and some community rating rules in the interest of lowering premium costs and insuring more people.
The amendment also included retaining certain ACA provisions like prohibiting discrimination based on gender and keeping dependents on parents’ plans up to age 26.
Another provision of that amendment, Meadows noted, protects a person with continuous insurance coverage from having their premiums increased in the event of a serious diagnosis or chronic disease.
A release from MacArthur’s office about the amendment says it explicitly maintains protections for pre-existing conditions and that no state, under any circumstances, “may ever obtain a waiver for guaranteed issue of coverage, guaranteed renewability of coverage, or the prohibition of denying coverage due to pre-existing conditions.”
The release also says those with pre-existing conditions won’t be priced out of the market because states would be required to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk-sharing program, and that no state may obtain a waiver for health status unless it has taken those steps.
Reps. Gary Palmer (R-Ala.) and David Schweikert (R-Ariz.), also Freedom Caucus members, introduced an amendment to the AHCA, Meadows said, that creates a high-risk pool at the federal level. This will also be a requirement to be adopted by states seeking a waiver for health status ratings.
Citing the Centers for Medicare and Medicaid Services, Kigler said that in Henderson County, data shows 6,782 Marketplace plan selections from Nov. 1, 2016 to Jan. 31, 2017. Ninety-two percent of those received an advance premium tax credit, slightly higher than the state average of 90 percent. The average monthly tax credit in the county is $620 a month.
Those plans don’t represent just 6,782 people, only plan selections, she noted, explaining that one of those plans may cover 10 people.