We explain the MacArthur amendment to the AHCA that allows states to waive essential health benefits, charge more for preexisting conditions, and exempts Congress.
More specifically, we explain an amendment to the Republican “ObamaCare Repeal and Replace plan,” American Health Care Act (AHCA), that has been proposed by Congressman Tom MacArthur (R-NJ) and subsequently discussed by Republicans.
TIP: The MacArthur amendment allows states to waive essential benefits, age ratings, and community ratings. It therefore could price people with preexisting conditions out of care indirectly. It doesn’t however allow for direct discrimination based on health status or gender.
Amendment #33 offered by the Hon. Thomas MacArthur (NJ) says:
“—The amendment allows states to waive essential health benefits, age rating, and community rating. Health insurers would not be allowed to [deny coverage,] discriminate based on gender or [limit access based on] preexisting conditions. States must explain how the waiver will reduce average premiums for patients, increase enrollment for residents, stabilize the state’s health insurance market, stabilize premiums for individuals living with preexisting conditions, or increase patients’ health care plan options.”
The gist of this is:
The planks of the amendment (detailed below) are accomplished by a set of three state-based waivers which you can read about at health affairs.
The result of this will be that, although it doesn’t exclude preexisting conditions explicitly, those with preexisting conditions not covered by the risk-pool could be pushed out of the market due to cost (along with some older Americans who have not yet reached Medicare Age).
The amendment later provides: “Nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with preexisting conditions,” but that is precisely what health status underwriting does. Health status underwriting could effectively make coverage completely unaffordable to people with preexisting conditions (in other words, by charging a sick person more the result is the same as if they were excluded; that is they don’t have access to coverage).
– Timothy Jost was explaining how state-based waivers for Community ratings can result in care for the sick rationed by cost.
As if the above wasn’t questionable enough, the MacArthur Amendment insultingly exempts Congress and their staff members from the changes.
They use confusing legal language that only a “wonk” could decipher (TIP: they did the same thing in the main bill with Planned Parenthood).
This hints they are purposefully trying to cover up unpopular items and ensure that government officials and their staff can keep the ACA (ObamaCare) despite any changes at a state level.
This means that conservative states would be able to file a waiver that lets them undo key ACA protections at a state level, but it protects staffers or congresspeople working in that state.
Simply, Congress is trying to pass a law that will charge sick and older Americans more and offer slimmer benefits, yet exempts them from state standards and allows them to keep ObamaCare’s protections.
Below is a quick list of pros and cons of the MacArthur Amendment.
Benefits are centered around the idea that having lax standards will result in less expensive plans. These plans have higher cost sharing and are less robust in terms of protections and coverage, but I think we all agree that cheaper plans would be a real boon right now!
With that in mind, the main benefit of the plan is that it could, by offering restrictive insurance with fewer benefits, increase competition in the marketplace and result in cheaper plans for employees. Many of these cheaper plans would be worse, but the competition could drive prices of those worse plans (and even better ones) down over time.
That may seem like a backhanded compliment, but it isn’t fully that.
The market system does work. Supply side, trickle down, and all economic theories involving deregulation and tax breaks for the rich do work (in some respects at least).
My doubt isn’t strictly put on the shoulders of supply side in general, it is rather that I don’t think supply side along is going to solve the healthcare crisis.
I’m not sure if “proper care” trickles down any better than “proper education,” and that is a real gamble for a nation who wants to remain #1 in the eyes of its citizens and the world.
In other words, it is a pro that deregulation is being used in some respects, but I can’t mention that pro without considerations. After-all, we are talking about healthcare, not luxury items.
Another benefit, at least for progressive liberals, is that the Amendment and AHCA, in general, imply that progressive states could offer increased benefits via a system like single payer at a state level (under separate ACA waivers).
However, unless funding is guaranteed, it would mean those states would be footing the bill for expanding health care (which again is “a pro, but with a consideration.”)
The main problem with this bill isn’t in the policy; it is the intention behind the policy. It is that Republicans seek lower cost plans for the healthy, shift costs to poor, sick, and elderly, shift profits to non-healthcare industries, add in deregulation for businesses, and do not seem to believe in providing universal healthcare.
In other words, the problem with this plan and Republicans in general is: They consider economics first, and healthcare goals second if it all. The correct way to come into healthcare is by saying, “we want universal healthcare, how do we do it?” Instead Republicans keep trying to solve the healthcare crisis with Reaganomics (trickle down, supply side).
The supply side idea here is that somehow health care will trickle down, alongside lower costs. The problem is, to what extent it doesn’t trickle healthcare all over the poor, sick, and elderly, it will mean tens of millions of uninsured Americans we have to rely on, as they always have, the emergency room.
Under the Emergency Medical Treatment and Labor Act of 1986, people cannot be denied care for life-threatening conditions in hospitals regardless of ability to pay (this is very good).
However, they will not receive treatment for care that might have prevented their health from deteriorating to such a critical point. Also, uncompensated care provided under the EMTALA is a significant cost that is passed along to the rest of us.
The problem is then, this isn’t a flat screen TV or a cell phone, it is healthcare.
This “ought to be” a human right, not a chance to try trickle down again while booting tens of millions of sick, poor, and elderly out of the market.
Secondary problems include:
This last section is a summary of the main planks in the amendment.
The first part on the waivers is a summary of what is explained by the health affairs blog post noted above, and the last three are a breakdown from business insider. The bill itself is written in a way that it constantly cites other bills, so it won’t be readable to the average person. This is, however, the gist of what it does:
TIP: Remember, all this is added to the AHCA (TrumpCare 1.0), and all of this is subject to change.
Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a.