GOP Group Quietly Pushes To Insulate Preexisting Conditions From TX Case03/06/20
A group of House Republicans blasted Democrats for refusing to move a legislative fix that would preserve the Affordable Care Act’s key preexisting conditions protections should the Supreme Court rule the individual mandate to be invalid along with the rest of the ACA. The Republicans’ little-known legislative push to carve out the ACA’s preexisting conditions protections from their own party’s lawsuit to scrap the entire law highlights how vulnerable some GOP lawmakers in moderate areas are to attacks over health care.
House Speaker Nancy Pelosi’s (D-CA) office declined to comment on the legislation, but a Democratic congressional aide said the bill falls short because it would not protect other key provisions of the health law.
Ohio Republican Dave Joyce first introduced the bill in July 2018 and reintroduced it in January 2019, a month after a Texas district court ruled in favor of the GOP attorneys general who say the mandate is unconstitutional without a penalty and the rest of the law cannot be severed and must also be thrown out. An appeals court has since also ruled the mandate to be illegal but didn’t weigh in on the remainder of the law. The mandate and the related severability issues are now set to be heard by the high court.
Joyce’s office tells Inside Health Policy that he’s pushed Democratic leadership to bring the bill to the floor as security for those with preexisting conditions regardless of what Supreme Court decides.
Joyce’s office pointed to a November 2019 letter from the lawmaker asking Pelosi to bring the bill to a floor vote despite differences in opinion on the viability of the ACA and a government-run health care system. Joyce wrote that the uncertainty surrounding Texas v. USA led to him reintroduce his bill in January 2019 in order to insulate preexisting conditions protections from an eventual Supreme Court decision.
“I think we can both agree that deliberate, bipartisan steps must be taken to protect coverage for this vulnerable population as the Affordable Care Act’s litigation inches closer to a conclusion,” Joyce wrote in the letter. “I stand ready to work with you and my colleagues across the aisle to advance my legislation, which would do just that.”
But since November, Joyce has seen no Democratic support for his bill, and thus no movement from the Energy & Commerce subcommittee to which it has been referred.
“Unfortunately, despite my repeated attempts to bring this bill to the Floor, I have not seen any interest in doing so from the majority,” Joyce told Inside Health Policy in a statement. “We have to move past talking points that serve only to perpetuate the endless, partisan messaging war that does nothing to fix the current instability of our health care system. This blue team versus red team mentality is preventing us from solving our nation’s problems and the American people are paying the price.”
Pelosi’s office did not respond by press time to requests for comment on whether she will consider the bill now that the Supreme Court may start oral arguments on the case in the fall.
Energy & Commerce ranking Republican Greg Walden (OR) told Inside Health Policy that he’s long advocated for such a bill and would have passed it though committee already if he were in charge.
“We could tomorrow pass legislation, and send it to the president, that protect people with preexisting conditions irrespective of what the court would decide about the constitutionality of the ACA,” Walden said. “Then the court could do whatever it wanted with the ACA and we’d adjust accordingly."
“The biggest issue for Americans now is cost of care -- that’s what we should be focused on,” Walden, who is retiring, stressed.
While Joyce suggests political motivations and longstanding talking points as the reason Democrats don’t want to move the bill, Democratic sources argue the issue is grounded in policy not politics.
“This is a misleading argument from Republicans who want to claim they’re protecting people with preexisting conditions, but the truth is the bill itself is totally inadequate and offers significantly less protections than people have now,” a Democratic aide says.
The aide says the bill leaves out similar protections for other key ACA provisions, such as essential health benefits, annual and lifetime limit prohibitions, actuarial value and medical loss ratio requirements, maximum out-of-pocket limits and premium assistance. The aide argues that these provisions help create comprehensive protection and make health care more affordable for low- and middle-income families, so a bill that neglects these provisions while anticipating the whole law to be overturned would make coverage out of reach for those families.
“A bill that creates a limited preexisting condition protection in a vacuum without the ACA’s other interconnected protections would result in lower quality coverage that is likely more expensive,” the aide says.
The bill specifically says that if a court invalidates the individual mandate, several provisions that protect people with preexisting conditions -- including those that prohibit discriminatory premium rates, guarantee availability and renewability of coverage, prohibit the limitation or exclusion of benefits and prohibit discriminatory eligibility rules -- must stand.
Cosponsors of the bill include Republican Reps. Michael Turner (OH), John Katko (NY), Anthony Gonzalez (OH), Jaime Herrera Buetler (WA), Dan Newhouse (WA), Rodney Davis (IL), Steve Stivers (OH), Bryan Steil (WI), Pete Stauber (MN) and Steve Chabot (OH), who signed on last week. The list also includes a lawmaker from one of the states whose attorney general seeks to end the law -- Indiana Rep. Susan Brooks.
The bill highlights how vulnerable Republicans are to charges that they won’t protect patients with preexisting conditions or other popular provisions of the law, sources say.
A recent Kaiser Family Foundation poll found 55 percent of Americans now support the ACA. Republican voters still largely hold unfavorable views of the ACA, according to KFF, but most still have moved on from repeal and replace efforts with only 3% now saying they favor such an action as a fix to the health care system.
President Donald Trump made repeated promises to maintain protections for patients with preexisting conditions in his February State of the Union address and budget plan, in which he omitted a budget proposal to repeal the law for the first time of his presidency.
Critics, however, say the sentiment from Republicans is misleading since the administration has thrown its support behind the Texas v. USA case and has failed to present specific policies that would maintain the preexisting conditions protections.
Beneficiary advocates previously told Inside Health Policy that Trump’s lack of a specific policy for preexisting conditions protections in his budget revealed the administration’s wariness to endorse a controversial move among voters in an intense election year.