One more time, everyone?

Essential health benefits, pre-existing conditions sticking points in latest repeal/replace negotiat

By —— Bio and Archives--April 21, 2017

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Keep this in mind as you listen to the whisperings from “Republican insiders” talking to the Worst Web Site in the World: Negotiations always look bleak before you get a deal. That’s why you don’t have the deal yet. That’s why they’re still negotiating.

The challenge in the House is to get to 216 votes, and they couldn’t do it the first time around because the House Freedom Caucus wasn’t satisfied. There’s no sense delving again into who was responsible for that. This time, HFC chairman Mark Meadows is negotiating directly with Tom MacArthur, the chairman of the moderate Tuesday Group, to try to get a deal that both groups’ members can back.

The fact that they’re trying to get to a deal is good news, but the problem was always going to be the intractability of a few sticky issues on which the members of the respective groups - either out of political considerations or ideological ones - have a very hard time agreeing on.

It basically comes down to two things:

  1. Essential health benefits
  2. Pre-existing conditions.

ObamaCare establishes certain benefits as “essential” for health insurance policies and requires that they be covered. This drives up premiums because a lot of people would not choose to have these things covered if it means they have to pay more for the policy. The Tuesday Group favors keeping Essential Health Benefits, while the House Freedom Caucus wants to get rid of them.

I think you know all about the issue with pre-existing conditions. ObamaCare says you can’t be turned down for health insuarance because you have a pre-existing condition. That sounds like the sort of thing you’d want to support, but the problem is that it allows people to game the system because they can skip out on paying premiums until they get sick, only to sign up and get full coverage. It’s like waiting until you’re on your death bed and buying a $1 million term life insurance policy. No insurer would sell you that policy under those circumstances, but under ObamaCare you can do that if you’re sick and no one can turn you down.

But it’s politically popular because people don’t think it through, and the Tuesday Group wants to keep it. The House Freedom Caucus doesn’t.

So Meadows and MacArthur are working toward a compromise that looks something like this:

The MacArthur Amendment would:

  • Reinstate Essential Health Benefits as the federal standard
  • Maintain the following provisions of the AHCA:
    1. Prohibition on denying coverage due to preexisting medical conditions
    2. Prohibition on discrimination based on gender
    3. Guaranteed issue of coverage to all applicants
    4. Guaranteed renewability of coverage
    5. Coverage of dependents on parents’ plan up to age 26
    6. Community Rating Rules, except for limited waivers Limited Waiver Option

The amendment would create an option for states to obtain Limited Waivers from certain federal standards, in the interest of lowering premium costs and expanding the number of insured persons. States could seek Limited Waivers for:

  • Essential Health Benefits
  • Community rating rules, except for the following categories, which are not waivable:
    1. Gender
    2. Age (except for reductions of the 5:1 age ratio previously established)
    3. Health Status (unless the state has established a high risk pool or is participating in a federal high risk pool)


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That’s from a memo supposedly obtained by Politico from “Republican insiders.” I’ll let you decide if you believe Politico has legitimate sources, but this does sound consistent with the thinking of the principals involved in the talks.

HFC members appear ready to sign on if states are offered waivers on Essential Health Benefits, but Tuesday Group members may not be so pliable. Why is hard to understand. A state waiving the EHB requirement doesn’t mean policyholders can’t get those benefits. It just means they would have to shop for an insurer who wants to provide them. Often an insurer will offer multiples kinds of policies, some offering all benefits and some offering more limited benefits in exchange for lower premiums. It’s never made sense as a matter of policy that the government would mandate insurers offer certain benefits to everyone - even people who don’t want them.

I hope the Tuesday Group members haven’t decided to give the HFC a taste of its own medicine by aping the HFC’s performance from last time around - continually adding more and more demands, and then finally walking away and refusing to vote yes on anything. That is the sort of petulance we really don’t need when there’s an urgency to repeal this law, stablized the markets and get back to a more rational approach to health care finance.

But like I said, the state of negotiations always sounds bad before you get to a deal. In the end I don’t think either side wants to let ObamaCare survive for lack of a consensus among Republicans - at least I don’t want to think they’re willing to see that happen.

I’d prefer no federal role at all in health insurance, and I’m willing to accept incremental steps in that direction rather than demand something perfect, fail to get it and end up stuck with ObamaCare. Obviously you want the best incremental steps you can get. Last time I think the House Freedom Caucus was unreasonable and acted in bad faith in their pursuit of the things they wanted. This time it appears the HFC is behaving more constructively. Let’s pray that the Tuesday Group does the same, and that we get this done.

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Dan Calabrese -- Bio and Archives | Comments

Dan Calabrese’s column is distributed by HermanCain.com, which can be found at HermanCain.com

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