With hopes of passing new legislation to replace the Affordable Care Act before a congressional recess begins this week, the Trump administration and House Republicans are eyeing new bill revisions that would erode consumer protections in the health law and make coverage less accessible for those with medical problems.
It was in large part opposition from the conservative House Freedom Caucus, led by Rep. Mark Meadows, R-N.C., that forced House Speaker Paul Ryan, R-Wis., cancel a March 24 vote on the GOP health bill. Conservatives opposed the original bill because they claimed it was too much like Obamacare, that its tax credits created a new entitlement program for the wealthy and didn’t eliminate enough Obamacare insurance regulations.
In an effort to secure caucus support this time around, Ryan and the Trump administration are discussing giving states the option to forgo an Affordable Care Act rule that requires individual insurers to cover 10 “essential health benefits,” including outpatient care, like doctor visits; emergency room services; hospitalization; prescription drugs; and maternity and newborn care.
The new Republican proposal, which is still being developed, also would allow states to scrap the Affordable Care Act’s “community rating” provision, which forbids insurers from charging sick plan members more than healthy ones.
The Freedom Caucus had sought both concessions during negotiations on the earlier House legislation but were rebuffed by moderates concerned about the impact on constituents.
After the Freedom Caucus met with Vice President Mike Pence and White House officials on Monday night to discuss the proposals, Meadows told reporters the legislative text of the new plan could come from the White House sometime on Tuesday.
He said the Freedom Caucus, while encouraged and “intrigued” by the new proposals, “would certainly need a whole lot more information before we can take any action either in support or in opposition.”
On Tuesday, Ryan said, “productive talks” with caucus members could help the legislation reach the 216 votes needed for House passage. He credited Pence with restarting the negotiations but said he didn’t want to impose an “artificial deadline” by pushing for a vote on the measure this week.
“Right now, we’re just at that conceptual stage about how to move forward in a way that can get everybody to 216,” Ryan told reporters Tuesday morning. “It’s important that we don’t just win the votes of one caucus or one group, but that we get the votes and the consensus of 216 of our members. And that’s kind of where we are right now.”
That could be easier said than done. Moderate House Republicans who originally opposed the bill because it would harm seniors and low-income Americans aren’t likely to gravitate to the new proposals.
On Monday, Pence and other White House officials also met with Republican members of the moderate Tuesday Group to discuss the latest health care bill negotiations.
Meadows acknowledged that a party divide on the legislation still exists. As negotiations continue, Meadows said, “it’s important that the new legislation strike a fine balance that recognizes the differences of each one of our districts.”
If need be, Meadows said, he’s willing to stay in Washington during the recess and work to secure passage of the new legislation. Although he’d like to see the measure pass the House this week, he too warned against “artificial deadlines.”
Scrapping the Affordable Care Act’s community rating would have a significant impact on how health insurance operates. A strict community rating means everyone in a pool of enrollees pays the same premium, so that the costs of sicker, more expensive plan members are spread across all those who buy coverage. The ACA’s modified community rating allowed for rates to vary based only on the risk factors of age, geographic medical costs and tobacco use.
The GOP’s plan to allow states to decide whether insurers can set rates based on a member’s health status could increase costs for sicker people, making it harder for them to afford coverage.
For people with moderate health problems, Meadows said, premiums would likely increase to reflect their added risk. Those with more serious, high-cost medical problems, however, could get financial assistance with their premiums, he said, from a proposed $115 billion high-risk pool fund that the GOP has proposed.
Others argue, however, that without the mandatory coverage of “essential health benefits,” the law’s limits on out-of-pocket spending would be “essentially meaningless” because they apply only to those essential services, according to a recent blog post by Timothy Jost, an emeritus law professor at Washington and Lee University.
The health law’s ban on annual and lifetime coverage limits also applies only to essential benefits, meaning they too would be eliminated under the Republican proposals.
“That means insurers could again effectively cap the amount they would pay for a consumer with a high-cost or long-term health need such as cancer treatment,” according to a recent blog by Sarah Lueck, a senior policy analyst at the liberal Center on Budget and Policy Priorities.
The benefits are a popular part of the Affordable Care Act for many consumers. Before the health care law known as Obamacare was passed, the market for individual insurance coverage sold outside the workplace was a treacherous environment for consumers. High coverage-denial rates, lean benefits and premiums subject to frequent increases were the norm.
A government report in 2011 found that 62 percent of individual plan members had no maternity coverage, 34 percent lacked coverage for substance abuse treatment, 18 percent had no mental health services and 9 percent lacked coverage for prescription drugs.
A return to those days, when basically no national rules governed what plans must cover, would likely result in more low-cost plans with lower-quality coverage.
House Democratic caucus chair Rep. Joe Crowley of New York called the idea of not covering pre-existing conditions “incredibly radical and going the wrong way. He said Republicans were “huddling in back rooms” in an effort to “rob” Americans of health coverage.
“The American people are going to be on to this,” Crowley said Tuesday. “When they go back to their constituents, they’re going to hear an earful about that.”
In a statement on Tuesday, Sen. Patty Murray, D-Wash., the ranking member on the Senate Health, Education, Labor and Pensions Committee, voiced similar concerns.
“President Trump and House Republicans should know,” Murray said, “that if they try once again to give power back to the insurance companies, increase costs and undermine care for people with pre-existing conditions, they’ll get the exact same result: a bill that would be devastating for patients and families – one that they would have to defend, and one that has absolutely no path to becoming law.”
On Tuesday, White House Press Secretary Sean Spicer sidestepped a question as to whether the bill would roll back protections for pre-existing conditions, which Trump opposed during the campaign.
“We understand the core principles of this, and we’ve got to make sure that whatever we do continues to get an outcome that grows the vote, not decreases the vote,” he said. “And so I don’t want to start prejudging where this thing is going to head at this point.”
A new poll released Tuesday by the Kaiser Family Foundation found that 75 percent of respondents want Trump to help make the Affordable Care Act work, while 19 percent – including 38 percent of Republican respondents – say the Trump administration should try to make the law fail and replace it later.
The poll, taken after the GOP canceled the March 24 vote, also found that 89 percent of Democrats, 78 percent of independents and 51 percent of Republicans – including 54 percent of Trump supporters – want the administration working to support the law.
Spicer said the talks between Congress and the administration had been “very productive.”
“The president would like to see this done,” he said, adding that “there are more and more people coming to the table with more and more ideas about to grow that vote.”
Spicer said Pence and White House Chief of Staff Reince Priebus “feel very optimistic with the tone of the conversation and the ideas that are coming out and the willingness of folks to find common ground.”