Thursday, April 20, 2017

Tom MacArthur's faith-based waiver for the AHCA

Representative Tom MacArthur, R-NJ, has taken the lead in advancing amendments to the AHCA designed to bring both the Freedom Caucus and the moderate Tuesday Group aboard.  For the moderates, MacArthur writes that there will be an additional $160 billion in funding over 10 years to increase tax credits for older buyers and preserve Medicaid coverage for new mothers (was that on the block?!) and addiction treatment. For the conservatives, an amendment has been published  that would allow states to opt out of prohibiting medical underwriting or requiring insurers to cover the ACA's Essential Health Benefits.

Actually, the amendment begins by purporting to restore EHBs, community rating and guaranteed issue, the prohibition on denying coverage or charging more to people with pre-existing conditions. But it then tacks round and enables states to seek "limited waivers" to amend the EHBs, community rating -- and medical underwriting, if the state establishes a high risk pool.

How are those waivers limited? There's the rub. Beginning in 2017, the Affordable Care Act enables states to seek waivers to change the structure of their ACA marketplaces, but requires that the state's alternative plan "provide coverage that is at least as comprehensive and affordable, to at least a comparable number of residents, as this title would provide; and that it will not increase the Federal deficit."

Before Trump was elected, it was presumed that a state wishing to put forward an alternative coverage scheme would have to provide detailed evidence, with statistical and budgetary analysis, that its alternative meets those standards. And while HHS Secretary Tom Price and CMS Director Seema Verma have signaled that they may look with favor on waiver proposals that model conservative ideas (like, say, the waiver concept brewing in Oklahoma), it's still presumed that states will have to make an at least nominally fact-based case.

Not so in the alternative fact world of Republican legislation. The proposed amendment to the AHCA requires that states applying for waivers make a profession of faith, not evidence:
States must attest that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions. The Secretary shall approve applications within 90 days of determining that an application is complete (my emphasis).
States must attest to a purpose, not demonstrate a likelihood of fulfilling that purpose. In fact they are required to aim for only one in a sequence of goals, including any "benefit" -- not for an interlocked set of mutually supporting goals as in the ACA. Finally, the HHS secretary is asked only to determine that an application is "complete" -- not that it is sufficient.

This waiver is a pure wave-through. States can do what they want.

1 comment:

  1. piease, there are no moderates in republican caucus. there is a right wing and an extreme right wing.