Washington – House GOP leaders hope to have another showdown over their plan to repeal and replace the Affordable Care Act next week, but the legislation may still lack the votes it needs for approval.
The bill failed last month because dozens of Republicans shunned it and not a single Democrat would support it. But GOP leaders plan to amend the American Health Care Act with a provision sponsored by moderate Rep. Tom MacArthur, R-N.J., that aims to win over enough conservative and moderate Republican holdouts.
The amendment would keep the federal mandate that insurers provide “essential health benefits” that include maternity, mental health care and other types of coverage. But it would allow states to apply for a waiver of this requirement if they can prove that would lower premiums and expand the number of people with health care coverage.
The MacArthur amendment also would allow states to apply for waivers that would let insurers charge people with pre-existing conditions higher premiums, as long as those states make a high-risk pool available to those patients.
It also would allow states to apply for permission to let insurers abandon “community rating,” which sets rates based on geography, not on age or other risk factors. But those states that allow insurers to rate patients individually would not be allowed to charge women more than men or older people more than five times the premium charged younger ones.
GOP leaders, who have negotiated with conservative Freedom Caucus members and moderate Republicans over the two-week congressional recess, hope the changes win the support of 18 to 20 GOP lawmakers who resisted supporting the American Health Care Act last month.
Democrats said the proposed changes only made the health bill worse.
“Last month, Republicans threw together a disaster of a bill that would jack up health care costs and strip insurance away from 24 million Americans,” said Sen. Chris Murphy, D-Conn. “Everybody hated it…Now, this monstrosity of a bill is back, and to make the bill more palatable to right-wingers, the big change appears to be the abandonment of the protections for people with preexisting conditions.”
Murphy said the bill is “yet another Trump promise shattered.”
“The Republican health care repeal bill was an unworkable, unpopular piece of garbage a month ago, and it still is today” he said.
The nation’s top medical groups, including the American Medical Association and the American Hospital Association, also have rejected the GOP’s “repeal and replace” bill.
Insurers wary of GOP approach
Health insurers are concerned the GOP health bill eliminates the Obamacare requirement most people purchase insurance. Insurers want more generous subsidies than the GOP plan proposes to help people afford their premiums, bringing them more customers and broadening the risk pool.
The American Health Insurance Act subsidies, in the form of refundable tax credits, would run from $2,000 annually for those under 30 to $4,000 for those 60 to 65. The credits would taper off for individuals who earn $75,000 or more a year. The Affordable Care Act has more generous subsidies for lower-income people.
Some insurers also were concerned about the AHCA’s proposed cuts to Medicaid, the joint federal-state health care plan for the poor.
Kristine Grow, spokeswoman for America’s Health Insurance Plans, said, “We are continuing to analyze various proposals as they are being introduced and discussed over the recess.”
Grow said insurers would back the requirement that people with pre-existing conditions receive coverage and support the establishment of high-risk pools if there is a mechanism in the new health care law that requires people to keep continuous coverage.
The American Health Care Act would penalize those who have lapses in coverage with a 30 percent surcharge on their premiums when they sign up for insurance again. Insurers say the penalty is not high enough.
The AHCA also would provide about $100 billion to the states in a “stability fund” that could be used to establish and subsidize high-risk pools. The MacArthur amendment would add another $15 billion to that fund. But some insurers say that is not enough.
“Generally, we have said we believe a federal stability fund for high-risk pools, appropriately funded, would be a positive step toward stability,” Grow said. “We will be analyzing the impact of specific proposals for how such funding and risk pools would work.”
Of greater concern for insurers is the future of an Affordable Care Act provision that helps subsidize co-payments and deductibles for low- and medium-income people.
House Republicans have sued to eliminate the program, which will bring the insurance industry about $7 billion this year. The GOP argued the payments are illegal because Congress never authorized them, and won in a lower court.
The Obama administration appealed, and the Trump administration said it would continue the payments pending resolution of that appeal.
But Congress must pass a budget by April 28 that would fund the government through the rest of the fiscal year, which ends Sept. 30, and insurers worry the cost-sharing program will be defunded.
Earlier this week, insurance executives met with Seema Verma, the new head of the Centers for Medicare and Medicaid Services, the agency in charge of the Affordable Care Act.
Grow said the industry appreciated the opportunity to meet with Verma on a number of topics, incuding the future of the individual market and Medicare and Medicaid.
“But (we) reiterated our most pressing concern: the instability in the individual market created by the uncertainty of funding for the cost sharing reduction (CSR) program,” Grow said.
Kelly Donnelly, a spokeswoman for Gov. Dannel P. Malloy, said she could not comment on “what Republicans in Congress may or may not do — especially when they aren’t offering a clear direction or vision. ”
“With that said, what we can say is that we continue to be concerned about stabilizing the marketplace,” Donnelly said.