POLITICS

Rep. Meadows answers critics on pre-existing conditions

Derek Lacey
dlacey@gannett.com
U.S. Rep. Mark Meadows PROVIDED PHOTO

While House Republicans are celebrating the passage of the American Health Care Act, many are criticizing the bill, saying a provision allowing states to waive certain requirements could leave people with pre-existing conditions priced out of coverage. 

U.S. Rep. Mark Meadows, who helped the amended bill gain enough support to pass the House 217-213, says recent amendments provide protections for people with pre-existing conditions.

"I think probably the biggest confusion is really a narrative that pre-existing conditions won’t be covered because of allowing people to rate insurance based on health conditions,” he said.

“If you’re one of the 176 million people” who get insurance coverage in a group plan from their employers, or are on Medicare or Medicaid, he said, there will be no changes in coverage for pre-existing conditions.

Who could be affected are the 9.3 million people in the U.S. who get coverage through the Obamacare exchange or the individual market, he said.

Meadows released a statement shortly after the House voted on the bill, saying the process was never about getting a win for Republicans or the Freedom Caucus, but "it's about getting a win for the countless Americans who are being crushed by the broken system of Obamacare."

In the statement, he said that from the earliest stages of the discussion, his goals were to bring down insurance premiums and to protect people with pre-existing conditions, that there is still work to be done and that he looks forward to working with the Senate to improve the bill. 

Just as he was instrumental in the House passing the amended bill, Meadows was instrumental in the failure of the bill’s initial form. The biggest issue he had was premiums, he said, as most people in his district would have seen a 15- to 29-percent increase in the short term.

The new version of the bill, provided North Carolina takes a waiver, he said, “will lower premiums for most of the people that I serve around 40 percent.”

Even if North Carolina doesn’t take the waiver, he expects premiums to drop around 22 percent.

Jaclyn Kigler, managing attorney for Pisgah Legal Services, said that PLS is very concerned about the bill as it stands now, but stressed that the Afordable Care Act is still the law and people can still get health insurance, with open enrollment slated to start in November. 

"We're watching it closely," she said. PLS is hopeful that many of the protections for low-income people and people with pre-existing conditions will be built back into any bill that comes out of the Senate. 

In terms of pre-existing conditions, she said, the proposal that passed the House essentially allows states to request a waiver to scale back certain essential benefits required under the ACA, known as Obamacare.

But the protections for people with pre-existing conditions in the bill are three-fold, Meadows explained, through three amendments to the AHCA which take measures to prohibit premium increases for major diagnoses or chronic conditions, create a federal high-risk pool and add more money for those high-risk pools.

Meadows worked with New Jersey Rep. Tom MacArthur on an amendment that made several changes to the initial AHCA. States would be allowed to obtain waivers from certain federal standards like essential health benefits and some community rating rules in the interest of lowering premium costs and insuring more people.

The amendment also included retaining certain ACA provisions like prohibiting discrimination based on gender and keeping dependents on parents’ plans up to age 26. 

Another provision of that amendment, Meadows noted, protects a person with continuous insurance coverage from having their premiums increased in the event of a serious diagnosis or chronic disease.

A release from MacArthur's office about the amendment says it explicitly maintains protections for pre-existing conditions and that no state, under any circumstances, "may ever obtain a waiver for guaranteed issue of coverage, guaranteed renewability of coverage, or the prohibition of denying coverage due to pre-existing conditions."

The release also says those with pre-existing conditions won't be priced out of the market because states would be required to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk-sharing program, and that no state may obtain a waiver for health status unless it has taken those steps. 

Reps. Gary Palmer (R-Ala.) and David Schweikert (R-Ariz.), also Freedom Caucus members, introduced an amendment to the AHCA, Meadows said, that creates a high-risk pool at the federal level. This will also be a requirement to be adopted by states seeking a waiver for health status ratings.

Citing the Centers for Medicare and Medicaid Services, Kigler said that in Henderson County, data shows 6,782 Marketplace plan selections from Nov. 1, 2016 to Jan. 31, 2017. Ninety-two percent of those received an advance premium tax credit, slightly higher than the state average of 90 percent. The average monthly tax credit in the county is $620 a month.  

Those plans don't represent just 6,782 people, only plan selections, she noted, explaining that one of those plans may cover 10 people.

"(The AHCA) could be devastating for folks on the lower end of the income spectrum," Kigler said, explaining that the flat tax credits proposed by the bill, which she doesn't support, only increase slightly with age and don't take into account cost or geography.

The bill doesn't completely, explicitly eliminate guaranteed coverage of essential health benefits or pre-existing conditions. But where she sees potential problems is with the impact of the state waivers and allowing the reduction of those essential health benefits, or the impact of putting people into high-risk pools and the potential that seniors will be charged more. 

There's a lot to look at in terms of how the law may be implemented, but right now, Kigler said, her interpretation is that it puts low-income folks at a much greater risk of losing coverage and not being able to afford it.

The big issue is the waiver, Meadows said.

Under the Palmer-Schweiker amendment, the federal high-risk pool would result in people with pre-existing conditions getting the same insurance rates as most other people in the health care market, he said.

Those people would be transferred to a state high-risk pool, and states, in conjunction with the federal government, would offset higher premiums resulting from pre-existing conditions.

Another amendment, authored by Michigan Republican Rep. Fred Upton, would add $8 billion to the high-risk pools to help offset premium costs.

Health status can only be considered if a person is living in a state that has received a waiver and has opted into the risk-sharing and federal high-risk pool, and if the person has gone without insurance coverage for more than 63 days and purchases insurance in the individual market.

If that person goes back to work with for an employer that offers insurance, pre-existing conditions must be covered.

The only time it’s an issue is going from employer coverage into the individual market. If a person goes without coverage for more than 60 days, Meadows said, the $8 billion from the Upton amendment would come into play.

The AHCA does away with the Obamacare penalty for not maintaining coverage and tries to provide “an incentive and safety net for those who want continuous coverage,” he said.

“I can say that my commitment to everybody that I represent was that we were going to protect those pre-existing conditions,” Meadows said. He added that he feels the three amendments “will not only be able to do that, but be able to do that (while) at the same time bringing down premiums.”

Waivers will allow policies to be more tailor-made to individual needs, he said, giving the example of a person beyond child-bearing years who would not have to pay for maternity care coverage. He added that original estimates show premiums dropping by as much as 38 percent.

While the amended AHCA hasn’t been scored by the Congressional Budget Office, an analysis of the original bill by the CBO estimated that 24 million people would lose insurance and that the bill would cut the deficit by $337 billion over the period of 2017-26.

A CBO score for the updated bill is coming, Meadows said. The additions will cost more, so the bill won’t save as much money, he said, and he expects the $24 million figure to be lowered by several million people.

He called it a “substantially better bill” in terms of what most Americans and his constituents expressed. Meadows said he thinks it’s time the people he served get a break from premiums going up year after year.

Meadows said he has spoken with N.C. Insurance Commissioner Mike Causey and members of his senior staff about the state waiver, and said that some states like California, New Jersey and New York “we know won’t take it.”

People have every right to voice their concerns, he said. With the three protections for pre-existing conditions in the bill, he said the more people learn about it, the more comfortable they’ll feel. 

Pre-existing conditions are a concern for him as well, he said, as his niece was diagnosed with leukemia at age 5, meaning she’ll always have a pre-existing condition even though she’s healthy today.

It’s about making sure that people like his niece are taken care of, and at the same time making sure that lowering premiums doesn’t get lost in the debate, he said.

Kigler said she's hopeful this is the start of a way to look at expanding coverage for those who felt it was unaffordable and protecting those who are benefiting from quality coverage. She'd like to see a bill passed that takes what the ACA has done and expands coverage to more people and helps to make it affordable.