What Fresh Hell Is This?

May 7, 2017

AHCA And Pre-Existing Conditions

In February of this year, three members of the Pennsylvania delegation of the US House of Representatives, Keith Rothfus, Mike Kelly, and Bud Schuster published this in the Pittsburgh Post-Gazette:
Our alternative will expand the options for individuals and families to access affordable insurance coverage. It will provide for a transition period where those currently on Obamacare will have ample time to choose a new plan that works best for them and their families. We will make sure that no one struggling with complex medical needs or pre-existing conditions is denied access to affordable health care options.
They were writing about their criticisms of Obamacare and their plans for an alternative - the AHCA.  The three clearly state that they'll make sure that "no one struggling with ... pre-existing conditions is denied access to affordable health care options."

No one denied access to affordable options - keep that phrase in mind.

This issue of "pre-existing conditions" has been around for a while.  In late April, Donald Trump said that "pre-existing conditions are in the bill."

Politifact rated that as "mostly false."  They explain:
In March, the Republican’s American Health Care Act died without a vote when Republicans couldn’t agree on the bill designed to replace the Affordable Care Act. Under the new bill, called ACHA, insurers had to cover pre-existing conditions, but they could have charged more for people who are recently uninsured.

The MacArthur amendment would allow states to obtain waivers to some requirements of the Affordable Care Act, including the "essential health benefits" provision that requires maternity care or mental health services.

The amendment has language that appears to protect those with pre-existing conditions stating that "nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with pre-existing conditions."

But experts say other parts of the amendment suggest that those with pre-existing conditions could struggle to maintain affordable health insurance.

The amendment permits insurers to set premiums based on the "health status" of an individual by looking at their current and past health status and make predictions about how much an individual will use medical care in the future, said Linda Blumberg, senior fellow in the Health Policy Center at the Urban Institute.

That’s where pre-existing conditions could come into play, because it would mean that the costs rise for consumers who are sicker, said Timothy Jost, Washington and Lee University School of Law emeritus professor.

"Health status underwriting is literally charging a higher (possibly much, unaffordably, higher) premium to people with pre-existing conditions," Jost said. "Under the MacArthur amendment, they could not be refused coverage, but insurers could impose high enough premiums that coverage would be unaffordable." [Emphasis added.]
Politifact, in another analysis of the MacArthur amendment states:
Matt Fiedler, a health care analyst for the Brookings Institute, said the AHCA would force people with a pre-existing condition to choose between two different pools of insurance coverage, both with "a very high premium."

"In either case, people with serious health conditions would lack access to affordable insurance options," he said.

The AARP opposes the AHCA for that reason.

So does the nation’s largest group of doctors, the American Medical Association, which said the AHCA will do "serious harm to patients and the health care delivery system."
Hmm the AARP and the AMA both oppose the AHCA - and by implication the defense of it by our good friends Rothfus, Kelly and Schuster.

On those waivers, the Brookings Institute states:
States would technically be required to satisfy certain criteria to receive a waiver, but as noted by Tim Jost, those criteria would be trivial to meet. The state would have to agree to operate a high risk pool, reinsurance program, or related program under other provisions of the AHCA. But that would often happen automatically, and the waiver process would not require the state to ensure that the program is adequately funded (or otherwise effective). Waiver applications would also be required to explain how the waiver would improve the state’s health insurance market along at least one of five dimensions. Those criteria would also be easy to meet. Indeed, one is “reducing average premiums” in the state, which almost any waiver of this type would achieve by driving many sick individuals from the market. [Emphasis added.]
Guess what happens if the high-risk pool isn't adequately funded?  As Avalere, a Health Care consulting firm put it:
Funding earmarked for high risk pools in the American Health Care Act will cover five percent of the total number of enrollees with pre-existing chronic conditions in the individual market today.
Avalere estimates that there are 89,000 Pennsylvanians with a pre-existing condition in the individual market (those most likely to be affected by the MacArthur amendment).

So given all this, Congressmen Rothfus, Kelly and Schuster, how does your alternative plan "make sure that no one struggling with complex medical needs or pre-existing conditions is denied access to affordable health care options" as you promised?  And how many of the 89,000 are in your districts? 

More importantly, how many people with pre-existing conditions in your districts did you promise to help but instead you just as easily screwed them out of whatever health coverage they could afford? 

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