House sends Senate bill that would abolish Medicaid expansion and open door to higher premiums for pre-existing conditions

By Al Cross
Kentucky Health News

The health-care bill passed Thursday by House Republicans would end the expansion of Medicaid in 2020, limit the program's funding after that to a fixed amount per person, and let states allow insurance companies to charge higher premiums to people with pre-existing conditions. On a 217-212 vote, the bill went to the Senate, which undoubdtedly will change it.

About 440,000 Kentuckians get free health care through the 2014 expansion of Medicaid to people with incomes up to 138 percent of the federal poverty line. They would be allowed to stay on the program, which covers a total of 1.4 million people but has a monthly turnover of about 30,000 people going on or off as they qualify or don't qualify. New enrollees wouldn't be allowed.

Harris Meyer reports for Modern Healthcare, "Many if not most of the 31 states that expanded Medicaid to low-income adults likely would end those coverage expansions if Congress ultimately approves the House Republican healthcare reform bill passed Thursday, state policy experts say."

The Republican governors of Ohio, Michigan, Arkansas and Nevada in a letter to House and Senate leaders that the bill “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states,” Kaiser Health News reports. “That pushback has also created doubts in the minds of some GOP senators.”

In debate about the bill, coverage of pre-existing conditions got more attention. An estimated 1.8 million Kentuckians, out of a population of 4.4 million, have some sort of pre-existing medical condition, according to calculations by the Center for American Progress, a liberal or progressive advocacy group, and cited by Kentucky supporters of Obamacare.

To waive coverage of pre-existing conditions, the state would have to show that doing so would help the insurance market and would have to create a high-risk pool for people with such conditions. Experts say such pools usually fail to provide adequate or affordable coverage because they require heavy government subsidies.

Rep. Brett Guthrie

“There are some estimates that very few states, if any, would go through the waiver process,” Rep. Brett Guthrie of Bowling Green, one of four Kentucky representatives who voted for the bill, told Terry Meiners of Louisville's WHAS Radio on Wednesday. “If people want to go down that waiver process, that's something that governors and state legislatures will have to answer to their citizens.” Guthrie worked on the bill as vice chair of the health subcommittee of the House Ways and Means Committee.

The bill, titled the American Health Care Act, failed to secure enough votes to reach the floor in March and was tweaked to win support, first from strong conservatives and then from more moderate Republicans.

Strongly conservative Rep. Thomas Massie of Vanceburg, one of 20 Republicans who voted against it, said on Twitter, “The AHCA is like a kidney stone; the House doesn't care what happens to it, as long as they can pass it.”

The other Kentuckian voting no was Rep. John Yarmuth of Louisville, the only Democrat in the state's delegation. He said after the vote, “This bill weakens healthcare protections for most Americans and leaves families worse off. I hope people will continue to make their voices heard and communicate their discontent to their senators as this irresponsible legislation moves forward.”

In a floor speech before the vote, Yarmuth said, “The question every member of Congress should be asking themselves today is, who in the world is better off because of today's bill? . . . Certainly corporations and millionaires, who will see more than a trillion dollars in tax cuts from this bill. And, at least in their minds, a few Republican members who are so desperate for some type of political victory they are willing to risk the health and well-being of their constituents to ram through a bill without hearing, analysis, or most alarmingly, any sense of morality.”

Rep. Harold "Hal" Rogers of Somerset, the senior member of the Kentucky delegation, said passing the bill was the responsible thing to do because the health-insurance system created by the 2010 Patient Protection and Affordable Care Act is breaking down. Almost half of Kentucky's counties have only one insurance company offering federally subsidized policies under the law.

Rep. James Comer of Tompkinsville said the bill would “allow states to better manage their unsustainable Medicaid programs, and repeal job-killing taxes and regulations, while still protecting people with pre-existing conditions.”

Rep. Andy Barr of Lexington said voting for the bill fulfilled his promise to “vote to repeal this broken law and replace it with reforms that will actually lower costs and expand access to care through patient-centered, market-based reforms.”

The bill is "making major dents in large portions of the current law but not outright repealing it," The Washington Post reported. "The bumpy, months-long process that led to Thursday’s vote also violated some of the GOP’s own promises on how they would govern. The measure proceeded without the benefit of an analysis from the Congressional Budget Office of its cost and impact on insurance coverage, and it did so after many Republicans openly acknowledged that they hadn’t read the bill. President Trump also promised 'insurance for everybody,' which the measure will not achieve." The 20 Republicans who voted no were "a mix of ardent conservatives upset that the bill didn’t fully repeal Obamacare and members from suburban swing districts worried about the political fallout."

Insurance companies and other health lobbies, such as the American Medical Association, objected to the bill, and its prospects in the Senate are guarded, the Post reports.