By David Cruz
If at first you don’t succeed – amend! If you thought the humiliating defeat of the American Health Care Act was the final round in the fight to repeal and replace the Affordable Care Act, Republicans – led by Congressman Tom MacArthur – have offered an amendment to the AHCA that they say bridges the gap between conservatives and moderates. But, as the amendment came into sharper focus today, cracks have started to appear.
“The individual market for health care is under great stress and I think it’s going to collapse,” said MacArthur.
Which was the rationale for the first effort to repeal and replace the Affordable Care Act. But that doomed effort, met with immediate push back from the so-called Freedom Caucus, conservatives felt the plan didn’t do enough to control costs. When it went down it looked as if that was the end of that. But then MacArthur, a second-term congressman, proposed his amendment this week.
The amendment allows states to opt out of ACA provisions, mainly, they can waive out of providing essential health benefits, like prenatal care, mental health care and emergency care, among others, mandated by ACA. They can waive out of covering pre-existing conditions and can waive out of a restriction barring higher premiums for seniors. MacArthur’s amendment would require states to create pools for high-risk patients.
“We should have a robust federal standard and I added those essential health benefits back, so even if states get a limited waiver, they’re still doing it against a full range of those federal benefits. And the only reason they can do it is to do other things that benefit their citizens, like bring the cost of health insurance down or increase the number of insured,” MacArthur told NJTV News today.
But critics say MacArthur is being disingenuous because the easy to attain waivers would do exactly the opposite, allowing states to offer bare bone health care plans that are cheaper but cover less and allow for high deductibles. They say MacArthur’s cure makes things worse.
“You can take out the benefits that someone would need who has a pre-existing condition, so, for example, an insurer could exclude high-cost drugs, and so a state could apply for a waiver to any of those things,” countered NJ Policy Perspective Senior Policy Analyst Ray Castro. “Basically, it makes it inaccessible, so, technically speaking, you’re not being denied on that basis but they can price them out of the market because of this amendment and that was a goal. I think the Freedom Caucus wanted restrictions on the pre-exisiting conditions and that’s what they got.”
House Speaker Paul Ryan, who took a blow from the failure of his effort last month, was supportive of MacArthur’s effort.
“Tom MacArthur had an entire career working in insurance, understanding the math and the mechanics and the actuarial science of insurance and has come up with a very innovative amendment that we think works really well and it gets to where we all want to go,” he said. “We want to bring down costs; we want to preserve insurance for people with pre-existing conditions and we want to respect the fact that states have different issues, different health care marketplaces and we want to give states greater flexibility to get the maximum reduction in policies and premiums so we can get the best possible health care system.”
But Congress agreed that the American Health Care Act was not that, and critics – like the American Medical Association and AARP – point out that this amendment puts the original bill back on the table.
“He retains everything in the old bill, which was a disaster for New Jersey,” said Castro. “I mean we know that in the marketplace, premiums are going to go up by about $3,000 and up to $7,000 for seniors who are low income. That’s going to price them out of the market and there are the huge cuts in Medicaid, which has a much bigger impact in New Jersey than it does in other states. The Urban Institute estimates that a 20 percent reduction in federal funding as a result of a cap on Medicaid is a $30 billion loss in our state.”
So, what are the prospects of this so-called MacArthur amendment? At this point, neither side can really say, but if you want to try to read the tea leaves, none of New Jersey’s Republicans say they’ll vote for it and one Midwest congressman added, rather cheekily, “I went from Hell no, to no. So, I guess that’s progress.” A vote could come as early as tomorrow or Saturday.