The
American Health Care Act (AHCA) as amended delivers relief from Obamacare’s
taxes and mandates that have hurt job creators, increased premiums, and limited
options for patients and health care providers. It returns control of health
care from Washington back to the states and restores the free market so
Americans can access quality, affordable health care options that are tailored
to their needs.
Obamacare
was based on a one-size-fits-all approach that put bureaucrats in Washington in
charge of your health care. The law led to higher costs, fewer choices, and
less access to the care people need.
The
AHCA will deliver the control and choice individuals and families need to
access health care that’s right for them. And provide the freedom and
flexibility states, job creators, and health care providers need to deliver
quality, affordable health care options.
THE UPTON-LONG AMENDMENT
The Upton-Long Amendment further strengthens
the American Health Care Act’s (AHCA) protections for Americans with
pre-existing conditions by providing an additional $8 billion in resources over
5 years to those with pre-existing conditions.
WHAT DOES THIS AMENDMENT DO? The
Upton-Long amendment strengthens the AHCA by reaffirming our commitment to
protect patients with pre-existing conditions.
HOW DOES IT WORK? It dedicates
$8 billion solely to reduce premiums and other out-of-pocket costs for patients
in the individual market with pre-existing conditions who do not maintain
continuous coverage and who live in states that receive a waiver to redesign
their insurance market.
HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? This
$8 billion is on top of the $130 billion available to states through the AHCA’s
Patient and State Stability Fund, which helps states repair their health
markets damaged by Obamacare.
States
can use the funds to:
cut
out-of-pocket costs, like premiums and deductibles
promote
access to preventive services, like getting an annual checkup, as well as
dental and vision care
promote
participation in private health insurance or to increase the number of options
available through the market
Further,
the AHCA provides a refundable tax credit to those without other health care
options so they can get – and stay covered – before they face a serious medical
event or suddenly fall ill. These combined resources reaffirm the commitment
from House Republicans to ensure Americans with pre-existing conditions are
protected.
THE MACARTHUR AMENDMENT
The MacArthur Amendment keeps our promises of
lowering costs and protecting high-risk patients by giving states greater
flexibility and more control over local insurance markets.
WHAT DOES THIS AMENDMENT DO? The
MacArthur Amendment provides states the option to apply for waivers from
certain federal insurance regulations that increase insurance premiums. This
new flexibility will allow states to design insurance frameworks that are right
for their unique populations, providing superior care and lowering costs for
patients.
HOW DOES IT WORK? Any states that apply for
a waiver must attest that its purpose is to reduce the cost of health care or
increase the number of people with health care coverage.
HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? The
amendment’s limited waiver for health rating requires states to set up a
program for high-risk individuals or premium stabilization, or to participate
in the federal invisible risk-sharing program. No state may obtain a waiver for
health status unless it has taken these efforts to protect those who might be
affected. In states with a waiver, individuals who maintain continuous coverage
could not be rated based on health status.
MYTHS AND FACTS ABOUT THE MACARTHUR AMENDMENT
Myth #1: This Amendment does not cover pre-existing
conditions.
FACT: The MacArthur Amendment explicitly maintains
protections for pre-existing conditions. NO STATE, under ANY
circumstances, may ever obtain a waiver for guaranteed issue of coverage,
guaranteed renewability of coverage, or the prohibition on denying coverage due
to pre-existing conditions. The amendment specifically clarifies that its
provisions cannot be construed as allowing insurers to limit coverage for those
with pre-existing conditions. All of these protections will remain the
law.
Myth #2: This Amendment will price those with pre-existing
conditions out of the market, making health care unaffordable for them.
FACT: The amendment’s limited waiver for health rating requires
states to set up a program for high-risk individuals or premium stabilization,
or to participate in the federal invisible risk sharing program. No state may
obtain a waiver for health status unless it has taken these efforts to protect
those who might be affected. In states with a waiver, individuals who maintain
continuous coverage could not be rated based on health status.
Myth #3: High-risk pools have traditionally been underfunded by
states and the federal government, resulting in poor coverage and high costs
for those who need insurance the most.
FACT: The AHCA sets aside $100 billion over ten years to help states
with high-risk pools and other innovations. It sets aside an additional $15
billion specifically for maternity care, mental health care, and substance
abuse treatment. And it sets aside an ADDITIONAL $15 billion for a federal
invisible risk-sharing program -- another innovative way to help people access
affordable coverage.
Myth #4: Under this amendment, States do not have to cover
essential health benefits.
FACT: This amendment ensures essential health benefits are the
federal law of the land and maintains other important protections. States have
the option to obtain a waiver regarding federal essential health benefits, but
the state must publicly attest its purpose for doing so (to reduce the cost of
health care coverage, increase the number of people with health care coverage,
etc.) and it must specify the benefits it will require instead of the federal
standard. NO STATE, under ANY circumstances, may ever obtain a
waiver for pre-existing condition protection, prohibition on gender
discrimination, for guaranteed issue and renewability, or for the right of
dependents to stay on a family plan up to age 26.
Myth #5: 129 Million Americans have pre-existing conditions and
could be denied coverage.
FACT: This legislation addresses the 7% of Americans on the
individual market, and those in the small group market. Anyone with
employer-provided coverage or government coverage (Medicare, Medicaid, Tricare,
VA benefits, etc.) would not be affected. Again, this amendment would not allow
any state to deny coverage to those with pre-existing conditions, and would
require the extensive protections described above for those with riskier health
profiles. It is also worth noting that many states required insurers to offer
coverage to those with pre-existing conditions before Obamacare was
implemented.
FREQUENTLY ASKED QUESTIONS (FAQs)
Q: Are Members of Congress and their staff bound to the same
rules as everyone else?
A:
Members of Congress should live by the same rules as everyone else. Period.
We're passing legislation to make a simple technical correction to ensure that
the American Health Care Act (AHCA) and its amendments apply equally to
everyone.
READ
THE BILL TEXT: H.R. 2192, To amend the Public Health Service Act to
eliminate the non-application of certain State waiver provisions to Members of
Congress and congressional staff.
Q: Why did you add the Upton-Long Amendment?
A: The
AHCA explicitly maintains protections for pre-existing conditions. Guaranteed
issue of coverage, guaranteed renewability of coverage, or the prohibition on
insurance companies denying coverage due to pre-existing conditions are all
maintained. All of these protections remain the law.
The
MacArthur amendment to the AHCA does allow states to seek a limited waiver to
allow the insurance companies to charge higher premiums for a person with a
health condition only if they do not maintain continuous coverage. The
MacArthur amendment only applies to the individual insurance market, where
roughly 7 percent of the country purchase coverage. This means that the
MacArthur amendment does NOT apply to 93 percent of Americans with
employer-provided coverage or government coverage (Medicare, Medicaid, Tricare,
VA benefits, and others).
In
order to obtain a waiver, the MacArthur amendment requires states to set up a
program for high-risk individuals or premium stabilization, or to participate
in the Federal Invisible Risk Sharing Program.
Importantly, these higher premiums could only be charged for a
period of one year to an individual who did not maintain continuous coverage. After
an individual has maintained continuous coverage for twelve months they would
then return to standard rates. This means that the protections against being
charged higher premiums for a health condition are preserved for every
individual market plan holder who maintains continuous coverage.
To
address the concerns of higher premiums being charged in the limited
circumstances detailed above, the Upton-Long amendment provides $8 billion
dedicated solely to reducing premiums or other out-of-pocket costs for the
limited group of individuals who:
Reside
in a State with an approved waiver
Have a
pre-existing condition
Are
also uninsured because they have not maintained continuous coverage, and
Purchase
health care in the individual market
This
funding is on top of the $130 billion available to states through the AHCA’s
Patient and State Stability Fund, which helps states repair their health
markets damaged by Obamacare. States can use the funds to cut out-of-pocket
costs, like premiums and deductibles. States may also use these resources to promote
access to preventive services, like getting an annual checkup, as well as
dental and vision care. States could use these resources to promote
participation in private health insurance or to increase the number of options
available through the market.
Further,
the AHCA provides a refundable tax credit to those without other health care
options so they can get – and stay covered – before they face a serious medical
event or suddenly fall ill. These combined resources reaffirm the commitment
from House Republicans to ensure Americans with pre-existing conditions are
protected.
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