Congressman Tom MacArthur (R-NJ), a co-chair of the moderate House Republican Tuesday Group, in consultation with Congressman Mark Meadows (R-NC), chairman of the conservative House Freedom Caucus, proposed an amendment to the American Health Care Act (AHCA) health reform bill that would allow states to opt out of certain Obamacare provisions to “encourage fair health insurance premiums” and propose high-risk pools for consumers with preexisting conditions.
Released on April 25, 2017, the “MacArthur amendment” would replace previous language in the AHCA that eliminated the essential health benefits consumer protections found in the Affordable Care Act, instead instituting waiver options for states to alter the age rating ratios higher than the 5 to 1 ratio currently proposed at the AHCA; determine the minimum essential health benefits as well as lifetime and annual limits on out-of-pocket expenses; or allow for underwriting of insurance plans based on health status coupled with financial assistance and/or high-risk pools for consumers with predictably high health expenses. The health-status underwriting proposal would only apply to consumers that had experienced a break of coverage for over 63 days, which is an alternative to the proposed 30% penalty for consumers that have not maintained minimum coverage in the March AHCA language. The age-rating waiver would become available to states effective in 2018; the other provisions would become effective in 2019 (health-status underwriting) and 2020 (essential health benefits provisions).
States interested in applying for any of these waiver programs would be required to describe the state-specific proposal and demonstrate how the waiver would:
-
Reduce average premiums for health insurance coverage in the state;
-
Increase insurance enrollment;
-
Stabilize the market for insurance coverage;
-
Stabilize premiums for people with preexisting coverage; or
-
Increase the choice of health plans in the state.
A widely-reported provision of the MacArthur amendment, which would have exempted Members of Congress and their staff from the essential health benefits and underwriting provisions of the bill, was rescinded by language offered on April 26.
While this amendment addresses the concerns of the House Freedom Caucus, one of the conservative wings of the Republican majority, it heightens the criticisms from Democrats and provider and consumer groups that the AHCA does not ensure protections for consumers and may not actually lead to more affordable coverage for vulnerable populations.
As of Monday, May 1, the White House has reported that there will be enough votes to pass this legislation in the House this week, before the House is scheduled to leave town on Thursday, May 4 for a one week recess. House Leadership is continuing negotiations with the Tuesday Group, comprised of moderate members of the GOP caucus who expressed concern with the earlier AHCA proposal and have concerns with the MacArthur amendment. It is expected that the revised AHCA will not receive any votes from the Democratic caucus in the House, and is uncertain to receive enough support in the Senate for passage.
The proposed MacArthur amendment is available here. Please see our previous coverage on the AHCA in our March 10, 2017 Client Alert and March 27, 2017 Health Headlines.
