Speaker Ryan’s Pre-Existing Conditions Statement, annotated.
On May 2nd, Speaker Paul Ryan issued a statement on his blog, speaker.gov, about the proposed MacArthur amendment to the American Health Care Act. Many of Speaker Ryan’s statements are disingenuous and twist meaning to convince voters and representatives that this is a cure-all for the woes of us with pre-existing conditions. This is not true. I’ve taken the time to annotate his statement (in italics).
VERIFIED: The MacArthur amendment protects people with pre-existing conditions. The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition. Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if that state has chosen to take care of the people through other risk-sharing or reinsurance mechanisms.
In their applications for waivers, states would have to show that the waiver would accomplish one or more of the following: reduce average premiums, increase enrollment, stabilize the market, stabilize premiums for individuals with pre-existing conditions or increase the choice of health plans. The federal government would have 60 days to approve the waivers.
Even if a state asks for and is granted a waiver, no person may be priced based on health status if they have maintained continuous coverage.
Any lapse in coverage will severely limit health coverage and pricing available for individuals with pre-existing conditions).
In addition to these protections, the AHCA provides significant resources at the federal and state level for risk-sharing programs that lower premiums for all people.
Not true at all; MacArthur Amendment states that insurers can set premiums based on the health status of an individual by reviewing current and past health, as well as based on predictions about how much an individual will use healthcare in the future. This can raise costs for women of childbearing age, aging adults, individuals with chronic health conditions, or minority groups predisposed to certain conditions like heart disease and diabetes. (However, the waiver program allows states to dictate what type of benefits and drugs insurers have to cover. Additionally, lifetime and annual limits, as well as the limit on out-of-pocket expenses only apply to “essential health benefits” which states would be able to dictate if they have a waiver.
VERIFIED: It provides a strict process to receive a waiver from federal mandates. Although it gives states an option to tailor coverage limitations, the process is very strict.
The process is not very strict, according to the language of the Amendment. Waivers are on a “default approval” status, which means all applications submitted for waivers are automatically approved unless the Secretary of Health notifies the State submitting the application, no later than 60 days after submission, that the application has been denied.
A state must explain how a waiver will reach the goals of lowering premiums, increasing enrollment, stabilizing the market/premiums, and/or increasing choice.
The Amendment states that the application must provide for one or more of the following: reducing average premiums for health insurance coverage (This does not include copays, out of pocket expenses, or deductibles); Increasing enrollment in health insurance coverage in the state (with no specifications); stabilizing the market for health insurance coverage; stabilizing premiums for individuals with pre-existing conditions (the term stabilizing is not defined); or increasing the choice of health plans in the state (which has nothing to do with quality of plans).
States must lay out the benefits they would provide. And most importantly, states may only apply for a waiver if they have their own risk pool in place.
High risk pools are plans that would be available to individuals who have been locked out of the health insurance market due to preexisting conditions. High risk pools offer insurance plans that are subsidized by the state government. Premiums are around twice as much as a typical insurance plan. These plans are currently not necessary due to the ACA and have been replaced by the marketplace. The passage of the AHCA would bring these back.
Again, the coverage of people with pre-existing conditions will be protected.
Again, false.
VERIFIED: It gives states flexibility in addressing health care premiums. The populations in different states have different health care needs. The health care system in Wisconsin is different than the health care system in Arizona.
This is true. But not in the way Paul Ryan thinks. Health outcomes are directly impacted by healthcare access (and by necessity, health insurance access and affordability). States spend different amounts of money on healthcare. This is based off of what is subsidized, what type of care is offered, and the robustness of Medicaid and medicare programs provided to those at greatest risk. The average healthcare spending per capita in the United States in 2009 was $8,175; Utah with the lowest spending at $5,031, Massachusetts at $9,278, and DC at $10,349. Rankings differ when you compare percent of gross state product. But this is merely spending. When we look at rankings of the “healthiest” states, this all falls apart. States like Mississippi have the lowest access to medical and dental care in the country, and consequently some of the highest obesity and smoking rates. Hawaii, on the other hand, consistently ranks high on the list of healthiest states, and also has some of the best access to healthcare, fewer uninsured adults, higher activity levels, and much lower than average obesity. Access to healthcare increases: physical, social, mental health; prevents disease and disability; increases quality of life; and increases life expectancy.
This amendment gives states the flexibility to address these diverse needs without letting the most vulnerable — whether it’s the elderly, children, or people with pre-existing conditions — fall through the cracks.
While states will have flexibility through the default waiver approval process, individuals in need will absolutely fall through the cracks. Coverage will technically be made available to all individuals, but preexisting conditions, lapses in healthcare coverage, financial ruin, and what side of the state line you live on will all impact health insurance access and affordability which directly impacts health outcomes.
VERIFIED: The MacArthur amendment will help lower premiums for Americans. Right now, under Obamacare, there are many states with only one choice of health care provider.
This is due to individual health insurance companies choosing not to comply with the ACA law and pulling out of ACA marketplace plans.
The premiums are out of control and many people, due to Obamacare’s costs, don’t really have health care.
Over a 5 year period, more than 19 million people gained health insurance coverage under the Affordable Care Act. Under the AHCA, that many people could lose affordable, accessible coverage.
This flexibility will increase competition in the marketplace, giving Americans more choices when deciding upon their health care plans and ensuring that health care premiums will decrease.
More choices does not equal more quality choices. It just means more choices that provide lackluster coverage for individuals who are most vulnerable.
References:
The MacArthur Amendment Text: http://docs.house.gov/billsthisweek/20170424/MacArthur%20Amendment.pdf
The American Health Care Act Text: https://www.congress.gov/bill/115th-congress/house-bill/1628/text
Healthcare.gov: https://www.healthcare.gov/glossary/high-risk-pool-plan-state/
Kaiser Foundation: https://ballotpedia.org/Total_healthcare_spending_by_state
Healthy People 2020: https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
The Urban Institute: http://www.urban.org/sites/default/files/publication/86761/2001041-who-gained-health-insurance-coverage-under-the-aca-and-where-do-they-live.pdf
