GOP Health Plan Spawns Worries 04/29 10:43
From cancer to addiction, doctors and patient groups are warning that the
latest Republican health care bill would gut hard-won protections for people
with pre-existing medical conditions. Some GOP moderates who may seal the
legislation's fate are echoing those concerns.
WASHINGTON (AP) -- From cancer to addiction, doctors and patient groups are
warning that the latest Republican health care bill would gut hard-won
protections for people with pre-existing medical conditions. Some GOP moderates
who may seal the legislation's fate are echoing those concerns.
In a strongly worded statement this week, the American Medical Association
said the Republican protections "may be illusory." The American Cancer Society
Cancer Action Network said the plan could take the nation back to a "patchwork
system" that pushes costs on people with life-threatening conditions.
Such stark messages may be connecting with lawmakers anxious about making
the right decision on issues that touch every family. Rep. Patrick Meehan,
R-Pa., said the rewritten bill "doesn't change the fundamental concerns I had
at the outset ... making sure people with serious medical conditions could get
affordable and adequate coverage." Count him among the GOP moderates who remain
And veteran Rep. Fred Upton, R-Mich., said Friday he's "not comfortable"
with the bill and would like to see it changed. A former chairman of the Energy
and Commerce Committee, Upton said he was concerned people with pre-existing
medical problems could face unaffordable premiums.
The Affordable Care Act passed under President Barack Obama requires
insurers to take all applicants, regardless of medical history. Patients with
health problems pay the same standard premiums as healthy ones.
The latest version of House Republicans' American Health Care Act would
allow states to opt out of the requirement for standard premiums, under certain
If a state maintains safeguards such as a high-risk pool, it can allow
insurers to use health status as a factor in setting premiums for people who
have had a break in coverage and are trying to get a new individual policy.
Critics of the Republican approach say there is no requirement that a state
must provide an affordable coverage option for those consumers.
Proponents say people in poor health would still be protected as long as
they maintain coverage. And the higher premiums would revert back to standard
rates after 12 months, assuming the customer could afford to keep paying.
"All they are doing is moving the venue where people are going to be
discriminated against," said AMA President Andrew Gurman. "It would simply give
them an escape clause for 50 states." The nation's largest doctors' group
supported passage of the Obama-era law, and is now pressing for a bipartisan
approach to fix problems with the program.
Gurman used the hypothetical example of a low-income worker with a new
"This is not the kind of thing you can put off for a while," he said.
"They're going to need urgent surgery, radiation. They are not going to be able
to work. If they lose coverage for more than 60 days, how are they going to
afford huge insurance premiums? That scenario is all too common, unfortunately."
Along with the AMA and other groups, the advocacy arm of the American Cancer
Society is raising concerns about another GOP provision that would let states
to get waivers from "essential health benefits." That's the requirement in the
Obama-era law that insurers must cover 10 broad categories of services, from
hospitalization to preventive care, from lab tests to mental health and
substance abuse treatment.
Part of the risk is that the ACA's financial protections, including no
annual or lifetime dollar limits on coverage, are tied to medical care under
the essential benefits.
"Without these protections in place, we are returning to the Wild West
again," said Kirsten Sloan, vice president for policy at the Cancer Action
Nonetheless House Speaker Paul Ryan, R-Wis., said recently he thought people
with pre-existing medical conditions would be better off under the GOP plan
because they'd have more options. "That's the whole goal," he said, "to make it
easier for people."
But Republican health economist Gail Wilensky said she's greatly concerned
about the latest shift on pre-existing conditions.
"It definitely gives the state the option, in a waiver process, of greatly
diminishing if not gutting the pre-existing conditions protections," she said.
High-risk pools can serve effectively as a backstop, she added, but House
Republicans have not provided enough money for them.
"I think this is flawed," Wilensky said. "The moderates in the House are
pushing back, and I can't imagine it getting out of the Senate."