News Outlets Obtained A Copy Of A Proposed Amendment To Republican ACA Alternative

CNN: A New GOP Amendment “Would Allow States To Weaken Several Key Obamacare Insurance Reforms.” CNN reported on a new draft amendment to the Republican Party's health care bill that “would allow states to seek waivers to weaken several key Obamacare insurance reforms that protect those with pre-existing conditions, including the benefits insurers must cover in their policies and the ban on allowing carriers to charge more based on a person's health background.” From the April 26 article:

GOP lawmakers in the House have taken the crucial step of putting their latest hope for a health care compromise on paper, circulating legislative text that could launch yet another round of health care talks just in time for the last of President Donald Trump's first 100 days in office.

A draft amendment obtained by CNN, first reported by Politico, gives renewed insight into where the GOP may be moving next. The amendment would allow states to seek waivers to weaken several key Obamacare insurance reforms that protect those with pre-existing conditions, including the benefits insurers must cover in their policies and the ban on allowing carriers to charge more based on a person's health background.

The amendment is an effort to once again try and bridge the gap between hardline conservatives in the House Freedom Caucus and more moderate Republican members -- a divide so wide that that when the compromise first emerged last week GOP aides remained skeptical that it would be enough to get leadership to the 216 votes it needs to pass the bill.

The amendment was negotiated between Tuesday Group leader Tom MacArthur, a New Jersey Republican, and House Freedom Caucus Chairman Mark Meadows, with consultation from the White House and House leadership. But there is still little proof that the amendment will finally be the breakthrough that gets the health care bill passed in the House. [CNN, 4/26/17]

Cable Morning Shows Failed To Devote Any Substantive Coverage To The Impact Of The Proposed Amendment

Morning Shows On CNN, MSNBC, And Fox News Discussed The New Amendment In 3 Segments With No Analysis Of The Policy Implications. The morning after the text of the draft amendment was published by the media, cable morning shows failed to report on the substantive impact of the proposal. CNN reporter Suzanne Malveaux reported briefly on the issue twice between 6:30 a.m. and 7:30 a.m. MSNBC featured one brief segment in which Robert Costa reported that the revisions do not mean there are enough votes for the bill. Fox News failed to address the subject at all. None of these outlets actually discussed the policy implications of the amendment. [CNN, New Day, 4/26/17, 4/26/17; MSNBC, Morning Joe, 4/26/17]

The Amendment Would Allow States To Gut Pre-Existing Conditions Coverage And The Essential Health Benefits Package

Vox: The Original Text Of The Amendment Would Let States Opt Out Of Obamacare Protections While Maintaining Those Protections For Congress. Vox’s Sarah Kliff reported that the original text of the amendment “would allow states to waive out of Obamacare’s ban on preexisting conditions,” but that it would include an exemption so that “Members of Congress and their staff would get the guarantee of keeping these Obamacare regulations.” After public backlash, it was announced that the exemption would be removed from the amendment. Unchanged in the proposed amendment is the option to “allow states to waive out of key Obamacare protections like the ban on preexisting conditions or the requirement to cover things like maternity care and mental health services.” From the April 25 article:

The new Republican amendment, introduced Tuesday night, would allow states to waive out of Obamacare’s ban on preexisting conditions. This means that insurers could once again, under certain circumstances, charge sick people higher premiums than healthy people.

Republican legislators liked this policy well enough to offer it in a new amendment. They do not, however, seem to like it enough to have it apply to themselves and their staff. A spokesperson for Rep. Tom MacArthur (R-NJ), who authored this amendment, confirmed this was the case: Members of Congress and their staff would get the guarantee of keeping these Obamacare regulations. Health law expert Tim Jost flagged this particular issue to me.

A bit of background is helpful here. Obamacare requires all members of Congress and their staff to purchase coverage through the health law’s marketplace, just like Obamacare enrollees. The politics of that plank were simple enough, meant to demonstrate that if the coverage in this law were good enough for Americans, it should be good enough for their representatives in Washington.

That’s been happening for the past four years now. Fast-forward to this new amendment, which would allow states to waive out of key Obamacare protections like the ban on preexisting conditions or the requirement to cover things like maternity care and mental health services. [Vox, 4/25/17; Twitter.com, 4/26/17]

HuffPost: “New Version Of Obamacare Repeal Would Gut Pre-Existing Condition Guarantee.” HuffPost’s Jonathan Cohn reported that the proposed amendment “guts pre-existing condition protections” because under it, “states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.” Cohn cited Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, who denounced the amendment, arguing that “this approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it.” From the April 26 article:

Rep. Tom MacArthur (R-N.J.) on Tuesday formally unveiled an amendment to the American Health Care Act, the bill to repeal Obamacare that Republicans tried to get through the House last month. The amendment, which HuffPost’s Matt Fuller first reported last week, is the product of negotiations among key Republicans, including Vice President Mike Pence.

[...]

The measure’s supporters insist that their proposal would not harm people with serious medical problems. In fact, a clause states explicitly: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But that is exactly what it would do.

[...]

Under the new proposal, insurers still couldn’t reject people who have pre-existing conditions. But states could allow insurers to charge those people higher premiums ― and to sell policies without Obamacare’s essential benefits.

Conservatives have long objected to these features of the Affordable Care Act, because they drive up premiums for younger and healthier people. What conservatives fail to mention is that, without these provisions, people with medical problems end up paying a great deal more for their health care, because they face much higher premiums or can’t find policies to cover their medical needs. Ultimately, many end up with no insurance at all.

A recent analysis by researchers at the liberal think tank Center for American Progress examined the likely effects of such a proposal on premiums for people with medical conditions. For conditions like asthma or diabetes without complications, the researchers predicted, insurers would seek premiums more than twice as high as the standard rates. For people with metastatic cancer, the researchers concluded, insurers would ask for premiums 35 times higher than usual ― pushing premiums well beyond $100,000 a year. Needless to say, that’s more than virtually anybody could or would pay for insurance.

“This approach provides access to people with pre-existing conditions in theory but not in practice, since they’d be charged astronomical premiums if states allow it,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said Tuesday evening.

[...]

“Essentially, any state that wanted a waiver would get one,” Timothy Jost, a law professor at Washington and Lee University, wrote in a blog posted Tuesday evening for the journal Health Affairs. And even states that wanted to keep the existing consumer protections in place could be under enormous pressure from insurers to change them.

Defenders of the Republican proposal are likely to insist, as they always do, that so-called high-risk pools can take of people with pre-existing conditions. But few experts familiar with the history of health policy take this vow seriously because such high-risk pools existed before and rarely worked well. [HuffPost, 4/26/17]

Families USA: “Repealing Essential Health Benefits Means Only the Wealthy Can Afford Good Coverage.” Families USA criticized the new proposal that “allows states to opt out of requiring that health plans cover the Essential Health Benefits” because it “would leave millions without any affordable health care options, forcing them to pay out of pocket for needed care or go without care all together.” The policy brief said that if the EHBs are not required, “plans would become very skimpy and once again discriminate against people with pre-existing conditions,” noting that “it would be a return to the days before the ACA where it was it nearly impossible for people to find affordable coverage that actually covered their health care needs.” From the April 26 policy brief (boldface original):

April 26 update: In an effort to get the votes needed to pass the American Health Care Act (AHCA), House Republicans are considering a proposal that allows states to opt out of requiring that health plans cover the Essential Health Benefits (EHB). 

EHB requirements ensure that everyone in the individual and small group health insurance markets has access to comprehensive coverage that actually covers the services they need.

Allowing states to waive the EHB requirements would leave millions without any affordable health care options, forcing them to pay out of pocket for needed care or go without care all together.

[...]

What would happen if the Essential Health Benefits are not required?

Plans would become very skimpy and once again discriminate against people with pre-existing conditions. Without a requirement to cover essential health benefits, two things would happen: 1) most insurers would stop offering comprehensive plans for fear of attracting people with high health care needs; and 2) the few plans with coverage for services like maternity care, mental health and substance use treatment, habilitative treatment, and even prescription drugs would become radically more expensive.

[...]

In total, it would be a return to the days before the ACA where it was it nearly impossible for people to find affordable coverage that actually covered their health care needs. Before these essential health benefits were in place, millions of people purchasing coverage on their own couldn’t get coverage for critical care. [Families USA, 4/26/17]

Methodology

Media Matters reviewed the raw video and transcripts for the April 26 edition of CNN’s New Day, MSNBC’s Morning Joe, and Fox News’ Fox & Friends via Snapstream. We searched for “health” and included any mention of the new health care amendment in the analysis.