After an epic fail in their attempts to repeal and replace the Affordable Care Act, Republicans have continued their pursuit of their own health care plan that would not only get to a vote on the House floor, but finally accomplish their goal of ridding the nation of former President Barack Obama’s signature legislation.
Again, led by House Speaker Paul Ryan, the GOP reportedly has recently advanced past the conceptual stage on a new health care bill. However, neither Ryan nor anyone else from the party have signaled they’re comfortable enough to put a timeline on a new proposal.
“There are ongoing talks that we are having,” Ryan told reporters last week. “We don’t have a bill text or an agreement yet, but this is the kind of conversations we want.”
Some of the changes that would make a health care bill more palatable for GOP members who opposed the original plan, reportedly include provisions that states would be allowed to apply for waivers to change the “Essential Health Benefits” in the Obama health law, which would be required in health insurance plans being sold to consumers.
That provision, according to some, would mean the ability to sell less expensive coverage plans.
Also, states would be allowed to seek an exemption from what’s known as “community rating” — which would allow insurance companies to get around the requirement in the Obama health law that people with preexisting medical conditions be charged the same as healthy patients.
Community ratings bars insurers from varying premiums based on health status or medical history and requires them, under “guaranteed issue” rules, to offer coverage to all who want it.
Thirty-six percent of those who sought individual insurance faced those obstacles in 2009, according to a survey by The Commonwealth Fund, a private health research foundation.
In 2010, nearly 1 in 5 who applied for individual coverage were denied because of their health status, according to Congress’ Government Accountability Office.
Serious conditions like heart disease, cancer, diabetes or depression could trigger coverage denials or drive up premiums. So could common ailments such as asthma, obesity, high blood pressure and high cholesterol, the News and Observer in Charlotte reported.
Under community rating, the entire pool of plan enrollees pay the same premium rates.
This spreads the higher medical costs of sicker plan members evenly among all who buy coverage. Rate variations under the ACA are allowed only for age, tobacco use and the cost of medical services.
Both guaranteed issue and community rating helped cut the number of uninsured people with preexisting conditions by 3.6 million, or 22 percent, from 2010 to 2014, according to federal estimates.
But with 24 million set to lose coverage under the GOP health care bill that’s being considered, the ACA’s record coverage gains and many consumer protections are in peril.
If House Republicans allow states to waive the community rating rule, individual insurers will again be able to charge plan members different rates based on their health.
Older people and sicker people, including those with preexisting conditions, wouldn’t fare nearly as well under the plan. They’ll once again have to pay more for health insurance.
That could leave many unable to afford it.
Some 52 million working-age adults have pre-existing medical conditions that would likely have left them unable to get health coverage before the Affordable Care Act, according to an analysis by the nonpartisan Kaiser Family Foundation.
In 11 states, at least 30 percent of non-elderly adults are estimated to have declinable medical conditions, the study found: West Virginia (36 percent), Mississippi (34 percent), Kentucky and Alabama (33 percent), Arkansas and Tennessee (32 percent), Oklahoma (31 percent) and 30 percent each for Louisiana, Missouri, Indiana and Kansas.
“Allowing states to eliminate the community rating requirement would also mean a return to invasive required questionnaires and paperwork that mandate medical exams tests, and other records to get coverage,” said a blog post Thursday by Sam Berger, senior policy adviser at the liberal Center for American Progress.
Prior to the Affordable Care Act, individual insurers routinely denied coverage, hiked premiums or imposed coverage exclusions on the policies of people who had medical problems before they signed up for coverage.
“Some states would get it right, allowing other states to copy the successful states,” Rep. Mo Brooks (R-Alabama) told the Atlanta Journal Constitution.
“When you have the federal government with a top down mandate, it’s either all right, or all wrong, or somewhere in between,” Brooks said.
While selling insurance across state lines and upping the cost for those with preexisting conditions are viewed by many as mandates that would hurt the poor and the elderly, conservatives in the Freedom Caucus would likely welcome the changes and support the bill, according to several Washington insiders.
However, moderate Republicans might pause.
“It has the potential to gain votes and lose votes,” said Rep. Mark Walker (R-North Carolina).
New Jersey Republican Rep. Frank LoBiondo said the proposed changes still hasn’t swayed him.
“I have seen nothing in terms of reported possible changes to the American Health Care Act warranting reconsideration,” LoBiondo said. “I remain a no.”