Over the last month, there have been a handful of revisions to the American Health Care Act (AHCA) that reflect member input. The latest are 1) an amendment provided by Rep. Tom MacArthur (R-NJ) that gives states flexibility in addressing premiums and best serving their populations; and 2) and an amendment by Rep. Fred Upton (R-MI) providing an additional protection for people with pre-existing conditions in states seeking that flexibility.
Here’s how the MacArthur and Upton amendments help us lower premiums while keeping protections for the most vulnerable in place:
VERIFIED: The MacArthur amendment protects people with pre-existing conditions.
The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition. Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if that state has chosen to take care of the people through other risk-sharing or reinsurance mechanisms. Even if a state asks for and is granted a waiver, no person may be priced based on health status if they have maintained continuous coverage. In addition to these protections, the AHCA provides significant resources at the federal and state level for risk-sharing programs that lower premiums for all people.
VERIFIED: It provides a strict process to receive a waiver from federal mandates.
Although it gives states an option to tailor coverage limitations, the process is very strict. A state must explain how a waiver will reach the goals of lowering premiums, increasing enrollment, stabilizing the market/premiums, and/or increasing choice. States must lay out the benefits they would provide. And most importantly, states may only apply for a waiver if they have their own risk pool in place. Again, the coverage of people with pre-existing conditions will be protected.
VERIFIED: It gives states flexibility in addressing health care premiums.
The populations in different states have different health care needs. The health care system in Wisconsin is different than the health care system in Arizona. This amendment gives states the flexibility to address these diverse needs without letting the most vulnerable—whether it’s the elderly, children, or people with pre-existing conditions—fall through the cracks.
VERIFIED: The Upton amendment adds another layer of security for people with pre-existing conditions.
The Upton amendment provides an additional $8 billion for states seeking a waiver. These resources will allow people with pre-existing conditions who haven’t maintained continuous coverage to acquire affordable care. The AHCA provides significant protections for people with pre-existing conditions, but these additional resources help ensure affordable coverage for individuals in states that have received a waiver. The money will be provided to the State and Patient Protection fund.
Bottom Line: The MacArthur and Upton amendments will help lower premiums for Americans while protecting the most vulnerable.
Right now, under Obamacare, there are many states with only one choice of health care provider. The premiums are out of control and many people, due to Obamacare’s costs, don't really have health care. The flexibility given by the MacArthur amendment will increase competition in the marketplace, giving Americans more choices when deciding upon their health care plans and ensuring that health care premiums will decrease. The protections put in place by both the MacArthur and Upton amendments protects people with pre-existing conditions, and ensures that there is no unwanted gap in coverage.