Community ratings, essential benefits at center of new GOP push to replace ACA
As President Donald Trump on Tuesday renewed his pledge to remake the nation's healthcare system, GOP lawmakers are continuing to look for ways to build a coalition strong enough to repeal and replace the Affordable Care Act.
The latest salvo is a compromise idea being floated by Reps. Mark Meadows (R-N.C.) and Tom MacArthur (R-N.J.), which was first reported by Politico. While the draft amendment would retain the ACA's provision that insurers cover 10 essential benefits, states would be able to seek a waiver to do away with that requirement. The draft amendment also aims to retool how premiums are set. Under the ACA, insurers calculate premiums using a community rating, which is intended to bring down costs for sicker members. Here too, the draft amendment would allow states to seek a waiver, freeing insurers to go back to using an individual rating system to set premiums.
The draft amendment, which hasn't been vetted by GOP leadership, is an attempt to appease the conservative Freedom Caucus, which thwarted earlier efforts to vote on the American Health Care Act. At press time, it was unclear when a new draft of the AHCA would be available or if votes will occur next week, as has been reported.
"We've consistently said that everyone should be covered, and that guaranteed coverage for everyone, including those with pre-existing conditions, must be coupled with continuous coverage provisions to help keep premiums affordable for everyone," said Kristine Grow, a spokesperson for America's Health Insurance Plans, adding that the group does not have a formal position on the draft amendment.
This latest chatter about AHCA doesn't seem to advance the ball very far, especially in regards to efforts to curtail Medicaid expansion, says industry analyst Paul Keckley.
"This will be the fourth iteration of the bill," he said. "But there's a point at which the 16 GOP governors who expanded Medicaid will say, 'If you whack my funding, we are going to have a problem.' Even if you give states more latitude on some of these issues, you can't put Medicaid into a free fall."
Tom Nickels, executive vice president of government relations and public policy at the American Hospital Association, said lawmakers need to move away from a construct that jeopardizes coverage for 24 million Americans who have benefited from the ACA's insurance provisions.
He and Keckley also noted that stabilizing the individual insurance market should be a priority. The AHA, AHIP and several other organizations last week sent a letter to the president urging action on funding for cost sharing reductions.
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