Republicans go to battle over pre-existing conditions

Senate Republicans are talking about including some of the same controversial waivers from a House bill repealing ObamaCare that critics say could hurt people with pre-existing conditions.

Sen. John Thune (S.D.) said he thinks a Senate bill will allow states to waive some requirements for insurers.

“I think there will be some authorities for states because, like the House, we want to give the states as much flexibility as possible,” said Thune, the No. 3 Republican in Senate leadership.

{mosads}A highly anticipated Congressional Budget Office report released Wednesday found the state waivers in the House bill could lead to skyrocketing premium costs for people with pre-existing conditions.

In states that waived certain coverage regulations for insurers, people could pay more than $1,000 per month for maternity coverage, the CBO found.

It also determined that many people with pre-existing conditions would be unable to afford coverage if they live in states that use the waivers.

“Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the CBO report said.

Asked how the Senate would avoid raising costs for people with pre-existing conditions, Thune said: “That’s what we have to try and do is come up with options in our version of the bill that prevent those types of outcomes.”

The language granting states the ability to waive certain rules was added in an amendment from Rep. Tom MacArthur (R-N.J.). The provision was key to the bill’s passage in the House, as it won the support of the conservative House Freedom Caucus.

Conservative lawmakers said they were determined that the House ObamaCare bill reduce premium costs, and the CBO estimates that the cost of premiums for healthy people would drop under the legislation.

The flip side of that, however, is that many people with pre-existing conditions in states that accept the waivers would see their costs soar.

And that’s a political problem given promises made by President Trump and GOP lawmakers that ObamaCare repeal would not lead to lost coverage for those with pre-existing conditions.

The House measure keeps in tact ObamaCare rules that prevent insurers from dropping people from coverage who have pre-existing conditions.

But it allows states to waive insurer requirements that could nullify those protections.

Specifically, states may allow insurers to charge some consumers more based on their health status. States could also drop requirements that insurers cover a list of 10 categories of services, including maternity care and mental healthcare.

A few Republican senators, such as Sen. Dan Sullivan (Alaska), are opposed outright to waiving the regulations.

Sullivan said he wanted to keep protections for people with pre-existing conditions that prevent insurers from dropping their coverage.

Asked if that meant the waivers, he said “no waivers.”

At the other end of the spectrum are Republicans who want to go even further than the House in allowing states to waive requirements.

“If we’re going to lower premiums, we have to give consumers flexibility to be able to purchase more affordable plans,” said Sen. Ted Cruz (R-Texas). “We have to give states flexibility to innovate to provide creative solutions so that those in need receive better care.”

Another conservative, Sen. Mike Lee (R-Utah), wants to repeal the ObamaCare regulations as a default and let states opt back in if they want.

Most GOP senators are on a middle ground where they want to keep the ability for states to waive the regulations but provide more funding than the House bill did for high-risk pools or other mechanisms to try to help sick people get coverage.

“We want states to have flexibility, but that’s why you need some kind of federal support or backstop like a risk pool or reinsurance so that people are comfortable that for chronic illness and pre-existing conditions, there’s going to be coverage there and that their premiums won’t become unaffordable,” said Sen. John Hoeven (R-N.D.).

He said the House bill did not have enough funding and that he wanted to consult with actuaries on how much is needed.  

Sen. Bill Cassidy (R-La.) has said that any bill that passes the Senate must meet the “Jimmy Kimmel test,” referencing an impassioned speech the talk show host gave in support of protecting those with pre-existing conditions.

Cassidy did not completely rule out waivers for states, if there is “very robust” funding as a backstop for sick people — more money than in the House.

He’s working on a plan to help ensure those with pre-existing conditions can afford their premiums, but declined to go into further detail.

“I’m running it by people who really know their stuff,” Cassidy said, “so before I talk about it, I’d rather, it may be that it’s just a dog. In the South that means something that’s not very good.”

But the Senate — much like the House — has to balance the wishes of both conservative and moderate members.

Senate leaders have made clear they face a tough path to getting to 50 votes, on this issue and others. With a 52-48 majority, there’s little margin for error.

“As Senator McConnell likes to point out, with 50 Senators needing to agree on this bill, everybody’s in a strong position, so we can’t roll anybody, so we’re going to have to continue to talk about that issue and try to come to consensus,” Sen. John Cornyn (Texas), the No. 2 Senate Republican, said. “There is no consensus yet.”