In March 2017, the American Health Care Act (AHCA), better known as Trumpcare, was pulled from the floor of the House of Representatives without a vote when conservative Republicans announced that they would not support the bill. The House Freedom Caucus, consisting of approximately far-right Republicans, said that the bill did not go far enough in repealing mandates under the Affordable Care Act (ACA), known as Obamacare. In late April, Republicans released the MacArthur Amendment, which won over the Freedom Caucus and alienated moderate Republicans at the same time, leading some to wonder whether this measure is enough to push the AHCA through the House, let alone both chambers.
Negotiation with House Freedom Caucus
Representative Tom MacArthur of New Jersey negotiated with the House Freedom Caucus to create the amendment. Representative MacArthur is the leader of the moderate Tuesday Group, which supported the original AHCA. The Tuesday Group has approximately 50 moderate Republican members. The White House and leadership in the House were both consulted about the amendment before it was released. Although originally released as the MacArthur-Meadows amendment, House Freedom Caucus Chairman Mark Meadows’s name was removed from the final version.
Obamacare and Pre-Existing Conditions
The primary language of the amendment allows states to seek waivers that would weaken some of the provisions included in Obamacare. One of those provisions relates to people with pre-existing conditions. Under Obamacare, people who have been diagnosed with a pre-existing condition, such as diabetes or cancer, cannot be denied health insurance coverage. In addition, insurance companies may not charge them higher premiums due to the pre-existing condition. Rep. MacArthur said that he likes this provision, but that this feature of Obamacare is contributing to the failure of the insurance system. Rep. MacArthur, who spent decades working in the insurance industry before his election to the House, also said that covering pre-existing conditions was important, but to make “one group pay unaffordable premiums is not the right answer.”
State Waivers for Pre-Existing Conditions
The amendment allows states to seek waivers for elements of Obamacare that protect those with pre-existing conditions. States would be allowed to request a waiver from the Department of Health and Human Services to charge insured people with pre-existing conditions a higher premium if their insurance lapses. States that apply for the waiver would be required to set up high-risk pools or other programs that would minimize exposure, which would offset some of the price increases that consumers could see if their insurance lapses. Rep. MacArthur says that the amendment prohibits any insurance company from denying coverage based on medical underwriting, a key feature of the current law.
Opt Out of Essential Health Benefits
In addition to waivers related to pre-existing conditions, states may also apply for a waiver that allows them to opt out of Obamacare’s essential health benefits provision. This portion of the ACA requires insurers to cover 10 essential benefits, including hospitalization, prescriptions, maternity care and mental health services, among other things. All health plans sold after March 23, 2010 must include these protections even if a consumer won’t need all of them. The MacArthur Amendment would allow states to offer policies that don’t cover these benefits. Instead, states could tailor their plans to suit the needs of individual consumers.
Many members of the House and Senate are concerned about the wording of the MacArthur amendment. Analysts warn that allowing states to obtain waivers in these areas could lead to many people losing insurance due to pre-existing conditions and that insurers would be less likely to offer comprehensive insurance plans because basic plans would be more attractive to those who have expensive health conditions.
Some experts say that the $130 billion set aside to fund the high-risk pools is much less than would be necessary to operate the pools. Ten patient advocacy organizations, among them the American Diabetes Association, American Cancer Society and National MS Society, believe the amendment will return the nation’s healthcare system back to an era when “people with pre-existing conditions could be denied coverage or forced to choose between purchasing basic necessities and affording health care coverage.” Others say that lower-income people are at risk of losing coverage if the bill passes into law in its current form.
During his campaign for presidency, Donald Trump repeatedly stated that pre-existing conditions would be covered in any healthcare bill he proposed. He promised to veto any bill that eliminated coverage for such conditions. Rep. MacArthur says that no person with a pre-existing condition will be denied coverage because of that condition and that the amendment only allows insurance companies to charge a higher premium to those with previous medical issues if their health insurance lapses. In addition, states would be required to prove that granting the waiver would lower premiums for their citizens.
Chances of Bill Passage
No Democrats are expected to vote for the AHCA, regardless of what amendments or adjustments are made to the proposal. This means that if more than 22 Republicans in the House vote against the bill, it will not pass to the Senate. According to The Hill, there are 21 Republicans who plan to vote no and 57 who have not made a decision. Only 16 Republicans plan to vote yes for the bill when it comes to the floor. Some of those who are now voting yes were planning to vote no before the amendment was added. Many of those who are undecided say that they want to review the revised bill before they make a commitment to vote one way or the other. Most of the Republicans who are undecided or against the AHCA are concerned about the language regarding people with pre-existing conditions.
Even if the bill passes in the House of Representatives, it has a significant uphill battle in the Senate. The amendment is already not sitting well with moderate Republicans in the Senate, where the GOP can only afford to lose two votes. Some GOP members of the Senate would like to see the bill die in the House so that they can focus on tax reform, which they feel is a much bigger issue.