Sharing some additional resources from the Center on Budget and Policy Priorities from Friday for those who want the really really really in-depth policy analysis version of the current amendment and ACHA.

 

 

Below is a paper and 3 blogs on the MacArthur Amendment and the House health bill.

 

·         Fact Checking Claims About the MacArthur Amendment

·         MacArthur Amendment Would Mean Return to Pre-ACA Law for People with Pre-Existing Conditions

·         History Shows Gutting Essential Health Benefits Would Likely Promote Fraud, Abuse

·         Roundup: The House GOP Health Bill’s Flaws Remain

 

Hope these are helpful.

Ellen

 

 

Paper: Fact Checking Claims About the MacArthur Amendment

 

“The MacArthur Amendment to the House Republicans’ Affordable Care Act (ACA) repeal bill would eliminate key ACA protections for people with pre-existing health conditions by allowing states to waive both the ACA’s standards for what health benefits insurance plans must offer and its prohibition on charging people more based on their medical history.  Just like before the ACA, insurers could discriminate based on medical history, eliminate coverage for key health services, and impose annual and lifetime limits on benefits, except in states that chose to prohibit these practices — which few chose to do before the ACA.  This brief report corrects a number of false claims made by supporters of the amendment.”

 

Read the full paper here: http://www.cbpp.org/research/health/fact-checking-claims-about-the-macarthur-amendment

 

MacArthur Amendment Would Mean Return to Pre-ACA Law for People with Pre-Existing Conditions

April 27, 2017 at 6:15 PM

by Jacob Leibenluft

http://www.cbpp.org/blog/macarthur-amendment-would-mean-return-to-pre-aca-law-for-people-with-pre-existing-conditions

Rep. Tom MacArthur has argued that his amendment to the House Republican bill to repeal the Affordable Care Act (ACA) will make “coverage of pre-existing conditions sacrosanct for all Americans.” In fact, it would do the exact opposite: end nationwide protections for people with pre-existing conditions and restore the pre-ACA status quo, when these protections existed only in states that chose to provide them.

Under the amendment, states would decide whether to stop plans from charging people with pre-existing conditions more and whether to require them to cover “essential health benefits,” such as maternity coverage, mental health and substance use treatment, and prescription drugs that people with pre-existing conditions need.

Here’s what it looked when states last made those decisions, before the ACA:

• 43 states and Washington D.C. let insurers charge higher premiums to people with pre-existing conditions; that is, they did not require full “community rating.” That means insurers could increase premiums by unlimited amounts for people with a history of cancer, hypertension, asthma, depression, or other conditions.
• Even in the seven states that required community rating, benefit standards were generally much weaker than they are today. For example, not all of these states required coverage of maternity care, not all required comprehensive mental health coverage, and almost all allowed insurers to refuse to cover some of the costs associated with people’s pre-existing conditions
• Overall, when states chose their own benefit standards, plans often failed to cover key services. Before the ACA, 62 percent of individual market consumers had plans that didn’t cover maternity care, 18 percent had plans that didn’t cover mental health treatment, 34 percent had plans that didn’t cover substance use treatment, and 9 percent had plans that didn’t even cover prescription drugs.

MacArthur wants you to believe that if you – or, more accurately, your governor and state legislature – like your insurance protections, you can keep them. But what the pre-ACA experience shows is that, faced with rising premiums, state policymakers would be under severe pressure to drop these protections.

Robust protections for people with pre-existing conditions weren’t sustainable for states without the rest of the ACA package: an individual mandate that people get health coverage or pay a penalty, and robust subsidies that keep individual market premiums affordable. Without them, states that tried to implement these protections found that premiums rose and markets were unstable due to adverse selection, with healthy people largely leaving the risk pool and leaving only those in poorer health enrolled. And under the House ACA repeal bill, those other ACA elements would be largely dismantled. Most immediately, the bill would eliminate the individual mandate, increasing premiums by 15 to 20 percent. Starting in 2020, it also would slash subsidies, increasing total out-of-pocket costs (premiums, deductibles, copays, and coinsurance) by thousands of dollars for millions of people.

As a result, states would face substantial pressure to seek waivers to eliminate the ACA’s pre-existing conditions protections and benefit requirements. Doing so would lower premiums for healthy people only at the expense of those with more serious health needs but, as the pre-ACA experience shows, it would likely strike many states as the only option to prevent their markets from falling apart.

And if states did seek waivers, getting them approved would be basically automatic. States would receive automatic approval for waivers within 60 days as long as they stated that the waiver would lower premiums, increase coverage levels, stabilize the market, stabilize premiums for people with pre-existing conditions, or increase the choice of health plans.

The end result would be a market that would likely look a lot like it did before the ACA: one in which people with pre-existing conditions lacked access to affordable plans that covered the benefits they needed, and in which even people with coverage were often one major illness away from medical bankruptcy. Notably, the MacArthur amendment would effectively let states waive even those protections it claims to preserve, including:

• Bans on annual and lifetime limits on coverage. Because the ACA’s bans on annual and lifetime limits only apply to essential health benefits, waivers of essential health benefits would also let insurers go back to placing annual and lifetime limits on coverage – not just in the individual market, but also for people who get coverage through their employers. Before the ACA, 105 million people nationwide had lifetime limits on coverage, 28 million of them children and the vast majority of them with employer coverage.
• Bans on charging women more than men. Eliminating essential health benefit requirements means that women would have to pay more for plans that included maternity coverage.

The American Medical Association; American Academy of Family Physicians, American Academy of Pediatrics, and other physician groups; the AARP; the American Cancer Society; and independent experts all agree: the MacArthur amendment guts pre-existing conditions protections. And the American public overwhelmingly believes that pre-existing conditions protections and essential health benefit requirements should apply nationwide, not just in states that choose to keep them.

That means House Republicans faced with a vote on the amended ACA repeal bill have a decision to make. They can go back on their promise that their health care legislation would “prohibit health insurance from denying coverage or charging more money to patients based on pre-existing conditions.” Or they can reject both the new amendment and the underlying bill that would lead 24 million people to lose coverage.

 

 

History Shows Gutting Essential Health Benefits Would Likely Promote Fraud, Abuse

April 28, 2017 at 10:00 AM

by Edwin Park

http://www.cbpp.org/blog/history-shows-gutting-essential-health-benefits-would-likely-promote-fraud-abuse

Permitting states to waive the Affordable Care Act’s (ACA) minimum benefit standards (“Essential Health Benefits,” or EHB) for individual and small-group market plans, as the MacArthur-Meadows amendment to the House ACA repeal bill would do, would likely leave many people with pre-existing conditions unable to find coverage at any price, cause women to be charged more than men, and expose many insured people to unaffordable out-of-pocket costs. But that’s not all. When paired with the House bill’s highly inadequate tax credits, eliminating the ACA’s EHB requirement also would likely lead to rampant fraud and insurer abuses — just like in the 1990s, with a similar credit that policymakers eventually killed.

In 1990, policymakers created a modest tax credit, tied to the Earned Income Tax Credit, to help low- and moderate-income families buy health insurance for their children. People could use it to buy children’s coverage in the individual market, without meaningful government benefit standards or safeguards.

Once the credit was created, a number of individual-market insurers began offering extremely scaled-back plans for children, with premiums set exactly equal to the credit’s value, and used high-pressure sales tactics to market them. Many lower- and moderate-income families enrolled their children, only to find that the plans often provided flimsy coverage and little protection against major health care costs.

Complaints of abuse mounted, prompting both a House subcommittee and the IRS to investigate. They found that insurers were selling many low-income working families nearly worthless policies. Some policies, for example, didn’t provide any coverage related to certain pre-existing conditions or had limits such as one outpatient visit per year. The investigations also found that many insurance agents were using misleading sales tactics.

The problems grew so serious that in 1993, Lloyd Bentsen, who had sponsored the credit in 1990 as Senate Finance Committee Chair and who was then serving as President Clinton’s Treasury Secretary, led the effort to eliminate it. President Clinton and Congress repealed it in 1993, and it’s widely considered a failure.

The House bill’s provision to create tax credits to buy individual-market plans could lead to similar abuses in states that waive the EHB requirements. In fact, some conservative health policy analysts strongly support the offering of such “no-premium” plans (so called because their premiums would match the value of the tax credit), including auto-enrolling uninsured people into them.

Notably, the House bill’s $2,000 credit for those under age 30 isn’t much bigger than the maximum value of the 1990s-era child tax credit, after adjusting for increases in private health care costs since then. So health plans designed to have their premiums match that credit would likely prove similarly inadequate as those designed to match the earlier child credit.

 

Roundup: The House GOP Health Bill’s Flaws Remain

April 28, 2017 at 4:15 PM

by CBPP

http://www.cbpp.org/blog/roundup-the-house-gop-health-bills-flaws-remain

The latest version of the House Republican bill to repeal the Affordable Care Act (ACA) would gut protections for people with pre-existing conditions, while making no changes to address the flaws in the underlying bill, we explained yesterday. Here are some key graphs and resources that highlight how the House bill would hurt coverage and affordability for millions of Americans:

Leaves Millions More Uninsured

House ACA Repeal Bill Would Be Largest Robin-Hood-in-Reverse Transfer in Modern U.S. History

[T]he House bill, if enacted, would represent the greatest assault on low- and moderate-income Americans of any law in modern times.

 

Cuts $839 Billion from Medicaid

Updated House ACA Repeal Bill Deepens Damaging Medicaid Cuts for Low-Income Individuals and Families

The updated House Republican plan takes an already damaging plan and makes it even more harmful for the tens of millions of children, seniors, people with disabilities, and other adults who rely on Medicaid.

Population’s Aging Would Deepen House Health Bill’s Medicaid Cuts for States

Due to the proposal in the House Republican health bill to convert Medicaid to a per capita cap or block grant, the aging of baby boomers would likely exacerbate the federal Medicaid spending cuts over the long run.

 

Increases Out-of-Pocket Costs for People Who Buy Insurance Through ACA Marketplaces

House GOP Health Bill Still Cuts Tax Credits, Raises Costs by Thousands of Dollars for Millions of People

The updated House Republican legislation raises total out-of-pocket health costs (premiums, deductibles, copays, and coinsurance) by an average of $3,600 in 2020 for people who buy health insurance through the ACA marketplaces.

 

Cuts Taxes for the Wealthy, While Middle-Income Families Lose

House GOP’s Proposed “Fix” for Health Bill Prioritizes Tax Cuts for Richest

In their updated health bill, House Republicans are doubling down on their plan to cut taxes for high-income households while cutting health insurance for mostly low- and moderate-income households…. [T]he updated bill would eliminate, for 2017, two taxes that fall only on high-income filers.

 

Harmful Impacts in Every State

State Reports: House Republican Health Plan Would Mean More Uninsured, Costlier Coverage

The House Republican health care bill would cause 24 million people to lose coverage by 2026, the Congressional Budget Office estimates. That means 1 in 10 non-elderly Americans who’d have health insurance under current law (ACA) would lose it under the House bill. These reports detail how the bill would affect people in every state.