The White House is working with Republican lawmakers in Congress to revive legislation that would repeal and replace core parts of the Affordable Care Act, but some of the changes being discussed to make this bill more palatable to opponents may take away one of the more popular aspects of the ACA.
According to lawmakers who have met with Vice President Pence and White House staff to discuss moving forward with repeal, one proposed change would allow states to apply for waivers to exempt themselves from a number of Affordable Care Act provisions.
Among the possible exemptions would be the ACA’s community rating system, which severely limits insurers’ ability to vary their premiums. The law currently requires that just about anyone within the same age range and geographic location be offered the same rate by the insurer. Allowing states to exempt themselves from this part of the ACA would give insurance companies the green light to charge higher rates to less-healthy people.
This possible tweak to the repeal plan retains the ACA’s prohibition against denying coverage to people with pre-existing conditions, but critics contend that it nonetheless has the effect of letting insurance companies price these people — particularly those in lower-income brackets — out of coverage because of their illnesses.
Rep. Mark Meadows (NC), chairman of the House Freedom Caucus, which largely stood against the previous repeal plan because it didn’t go far enough, told reporters on Monday that the plan accounts for people with high-cost coverage by allowing them to buy into risk-sharing pools.
“Those that have premiums that would be driven up because of catastrophic illness or long-term illnesses, we’ve been dealing with that for a long time with high-risk pools, so we believe in doing that is a way to keep premiums down for everybody to ensure everybody’s covered and ultimately where you don’t get priced out of the market,” explained Meadows, according to Bloomberg.
As the NY Times notes, such pools existed before the ACA, but they had a history of being expensive, with limited benefits.
Meadows also said on Monday that states may be able to exempt insurers from ACA requirements that they cover things like mental health care, substance abuse treatment, maternity, and even prescription drugs.
The congressman said there is “no deal in principle,” but also said he expected to see a draft of the latest version of the bill today. The White House is reportedly pushing for a vote on this bill as soon as possible. The House begins a two-week recess on Friday. Upon its return it has only a few days to pass a spending measure to avert a government shutdown.
It also remains to be seen how this change, intended to win over conservative critics of the pulled repeal plan, will be seen by moderate Republican lawmakers who opposed that plan for being too harsh.