NEWS

GOP promises pre-existing protections, but experts wary

Deirdre Shesgreen
Gannett Ohio

WASHINGTON—Under fire from constituents worried about their health coverage, Rep. Pat Tiberi is touting a new GOP bill that promises to preserve protections for patients with pre-existing conditions.

Rep. Pat Tiberi, R-Ohio, right, at a House committee meeting, is pushing legislation that would preserve the part of Obamacare which requires insurance companies to cover people with pre-existing conditions.

“I’m listening and I agree,” Tiberi tweeted on Tuesday, linking to a press release highlighting his support for the new Republican proposal.

But health experts say the GOP legislation on pre-existing conditions is more public-relations move than bankable policy promise. It would not work as a stand-alone measure, and it illustrates the difficult balancing act Republicans face as they try to unravel the Affordable Care Act without introducing more instability and premium hikes into the insurance market.

Under the Affordable Care Act, insurers are barred from denying coverage to people with pre-existing conditions — which can include anything from asthma to diabetes to pregnancy — and they also cannot charge higher premiums to those with pre-existing conditions. It’s one of the most popular provisions of the ACA, also known as “Obamacare.”

As Republicans move to “repeal and replace” that law, Tiberi and other Republicans have come under pressure from angry voters and liberal activists who fear the GOP plan will allow insurers to once again discriminate against patients with pre-existing conditions. They circulated petitions demanding that Tiberi hold a town-hall meeting to talk to constituents about the ACA, a plea he has refused so far in lieu of smaller sessions.

“We've called, we've written, we've begged, and Rep. Tiberi still refuses to schedule a town hall to tell us what his plan is to replace the Affordable Care Act,” reads one missive, organized by Indivisible, a loose coalition started by Democratic ex-Hill staffers to help voters become involved in advocacy and reach elected their representatives.

That group and other activists held a town-hall session in Tiberi's district -- without Tiberi -- on Wednesday, with voters sharing their stories of being helped by the ACA. The Indivisible group in Tiberi’s district has already collected a series of personal accounts from his constituents who have benefited from the law.

Olivia Hnat, a spokesman for Tiberi, said the congressman was not available for an interview on Wednesday. She said he has already met with people from Indivisible, along with other constituents, and he believes it’s more productive to hold smaller group sessions than a town-hall.

“Rep. Tiberi has scheduled back-to-back meetings with constituents to discuss healthcare reform over the past several weeks in his central Ohio office,” Hnat said. “These are important opportunities for Rep. Tiberi to listen to their concerns, respond to them directly and engage in a constructive conversation.”

Tiberi is chairman of a key health subcommittee, giving him a leading role in crafting the GOP alternative to Obamacare. That has also made him a high-profile target for those who support the law. And he’s clearly feeling the heat, as his tweets and statements this week demonstrate.

“We are taking a deliberate, step-by-step approach to deliver the quality, affordable health care reforms that Americans were promised years ago,” Tiberi said in his press release on Tuesday, touting his support for the “Pre-Existing Conditions Protection Act.”

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Oregon GOP Rep. Greg Walden, chairman of the House Energy and Commerce Committee, introduced the bill last week. It would bar insurance companies from denying coverage to patients with pre-existing conditions, something they did regularly before the ACA passed in 2010, and it would only go into effect if the ACA is repealed.

“This is the first step toward keeping our commitment to protecting vulnerable patients from being treated unfairly,” Walden said in a Feb. 16 statement outlining his proposal. More than 40 Republican lawmakers signed on as co-sponsors before they returned to their districts this week to face anxious constituents.

But health policy experts say it will not work—unless Republicans also keep the ACA’s mandate requiring Americans to purchase insurance or come up with another mechanism that gets healthy people to sign up for coverage.

“It’s not a statement of policy that can stand on its own two feet,” said Joseph Antos, a health policy scholar at the American Enterprise Institute, a conservative-leaning think tank. “It’s a statement of principal.”

Timothy Jost, a professor of health law at Washington and Lee University, said how the bill would work is "a complete mystery to me."

Here’s why: If Republicans repeal the mandate requiring people to buy insurance while also forcing insurers to cover those with serious illnesses, that opens insurance companies up to “adverse selection.” That’s when sick people sign up for insurance and healthy people do not, leaving insurers with unsustainable costs and sticking Americans with sky-high premiums.

“I don’t know how you could protect people with pre-existing conditions once you get rid of the mandate,” Jost said.

In addition, Jost said that while Walden’s bill would not allow insurers to deny coverage to those with pre-existing conditions, they could still discriminate against such patients by charging them dramatically higher premiums.

Under Walden’s proposal, “you can say as an insurer I will certainly cover you, and I will cover your pre-existing condition, you’re premium is $5,000,” said Jost.

Kristine Grow, a spokeswoman for America’s Health Insurance Plans, the industry’s lobbying arm, said she could not comment on the specific GOP bill. But she said the ACA’s mandate was a tool to broaden the “risk pool” by encouraging healthier people to enroll.

Without that kind of incentive, she said, “it risks instability and it risks increasing the costs to the people who are buying insurance even more.”

House Speaker Paul Ryan, R-Wis., issued a broad outline of the GOP’s “replace plan” last week, but it did not give many details about how they would encourage healthy people to get insurance. Republicans have crusaded against the mandate and vowed to kill it, along with the Obamacare federal subsidies that help low-income individuals purchase insurance.

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Hnat, Tiberi's spokeswoman, did not answer emailed questions about how the pre-existing condition protection would work without a mechanism to make individuals buy insurance. She instead offered background information about the failure of the Obamacare mandate.

The GOP plan outlined by Ryan calls for giving Americans a fixed monthly tax credit to help cover the cost of private insurance and expanding Health Savings Accounts, which allow workers to save their own money, tax free, for healthcare expenses. Republicans say that will give patients more flexibility to purchase the insurance they need—without all the expensive bells-and-whistles mandated by Obamacare.

“We want to make sure people have more choices than they do today,” Tiberi said in a radio interview last month. “We also want to make it portable, meaning if you change jobs you can take your health care with you.”

Antos said the real problem for Republicans is not getting rid of the mandate or the federal subsidies.

“The mandate didn’t really work,” he said, in part because of the weak tax penalties for those who flouted it. “And the subsidies didn’t work enough to drag in really healthy people.

“ … The issue is, where do you get the money to pay for people who are not going to be able to pay for the full cost of their own care,” he said. “What we’re talking about is money.”

Republicans have promised to repeal the tax increases included in the ACA, so it’s not clear where they would get the revenue to fund their alternative plan. Ryan said GOP leaders will spell out their plan in more detail when lawmakers return from their break next week.