Many House Republicans are now defending ObamaCare’s protections for people with pre-existing conditions, in the face of an effort by the conservative House Freedom Caucus to repeal them.
Some Republican lawmakers are also speaking out in favor of ObamaCare’s expansion of Medicaid and its mandates that insurance plans cover services such as mental health and prescription drugs.
Rep. Patrick McHenry (R-N.C.), the GOP’s chief deputy whip, said Wednesday that the Freedom Caucus's calls for states to be able to apply for waivers to repeal pre-existing condition protections are “a bridge too far for our members.”
Those ObamaCare protections include what is known as community rating, which prevents insurers from charging higher premiums to people with pre-existing conditions, and guaranteed issue, which prevents insurers from outright denying coverage to them.
McHenry spoke in personal terms about the importance of keeping in place those Affordable Care Act (ACA) provisions, contained in Title I of the law.
“If you look at the key provisions of Title I, it affects a cross section of our conference based off of their experience and the stories they know from their constituents and their understanding of policy,” McHenry said.
“My family history is really bad, and so my understanding of the impact of insurance regs are real, and I believe I'm a conservative, so I look at this, understand the impact of regulation, but also the impact of really bad practices in the insurance marketplace prior to the ACA passing,” he continued. “There are a lot of provisions that I've campaigned on for four election cycles that are part of the law now that I want to preserve.”
McHenry’s defense of those ObamaCare pre-existing condition protections is striking because just last year, House Republicans touted a healthcare plan, called A Better Way, that would have repealed the protections and replaced them with a different system.
Rather than ObamaCare’s protections, the Better Way plan would have protected people with pre-existing conditions only if they maintained “continuous coverage,” meaning they had no gaps in coverage. Unlike under ObamaCare, the plan would not extend the protections to people who were uninsured and trying to enroll in coverage. For those people, Republicans proposed subsidizing coverage through separate high-risk pools.
During a town hall at Georgetown University last year, Speaker Paul Ryan(R-Wis.) called for repealing ObamaCare’s community rating protection and allowing insurers to return to the days of “underwriting,” when they could charge people with pre-existing conditions more. Instead, sick people could get coverage subsidized through high-risk pools, he said.
“Open up underwriting, have more insurance companies, have more competition, and just pay for the person with the pre-existing condition to make sure that they can get affordable coverage when that moment happens and make it much more competitive for everybody else,” Ryan said then. “I think it’s a smarter way to do it economically and it gives people more freedom, more choices.”
Now, though, many House Republicans are defending the ObamaCare protections.
For example, in addition to McHenry’s comments, Rep. Tom Reed (R-N.Y.) this week called community rating a “very significant reform” made by ObamaCare.
Conservative groups are frustrated to see Republicans offering the defense. They say these Republicans are going back on their word to repeal ObamaCare.
Heritage Action this week sent out a fact sheet, citing the Better Way plan, titled “House Republicans Campaigned on Repealing Obamacare’s Community Rating Provision.”
The group’s CEO, Michael Needham, held a press call to blame moderate House Republicans in the Tuesday Group for blocking a deal.
“I think the Tuesday Group clearly wants to keep ObamaCare in place,” Needham said.
It’s not just the pre-existing condition protections that GOP lawmakers are defending.
Many Republicans from states that accepted ObamaCare’s expansion of Medicaid are supporting keeping it.
A group of Republican senators, including Sen. Cory Gardner (R-Colo.), the chairman of Senate Republicans’ campaign arm, last month objected to a draft of the House GOP repeal bill because it did not “provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.”
The House bill would effectively end the Medicaid expansion starting in 2020. Rep. Chris Smith (R-N.J.) warned that change “affects so many of our disabled individuals and families, and the working poor.”
Republicans had long derided ObamaCare’s “essential health benefits,” which mandate 10 health services that insurance plans must cover. They have said, for example, that men should not be forced to pay for plans that cover maternity care.
But now some Republicans are speaking up in favor of those requirements, including the chairman of the powerful Appropriations Committee, Rep. Rodney Frelinghuysen (R-N.J.).
“In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues,” Frelinghuysen wrote in a statement last month announcing he would oppose the House GOP repeal bill.
House Republicans even touted an amendment on Thursday that they said would bring down premiums by the government helping to pay for the costs of high-cost enrollees. That program is very similar to one that already existed in ObamaCare, called “reinsurance.”
McHenry, asked if his defense of the pre-existing condition protections was an acknowledgement that ObamaCare had done some good, said: “It is an awful bill on the main, but there are a few little kernels here that have had a good impact for eliminating the worst practices within the insurance marketplace.”
Rep. Mark Meadows (R-N.C.), chairman of the conservative Freedom Caucus, this week pushed back on the argument that his claims are a “bridge too far” for most of the conference, saying “anything less” than full repeal is not a bridge too far.
But he acknowledged that many of his colleagues don’t support full repeal of ObamaCare, long a central tenet of the party.
“Full repeal of ObamaCare may be a bridge too far,” he said, later adding: “We wouldn't be having the problem we're having if that weren’t the case.”