"Our members campaigned on this bill. Heck, about a dozen Freedom Caucus members co-sponsored the Price bill, which is what this is."—Speaker Paul D. Ryan, March 10, 2017
Better Way Promise
"Patients with pre-existing conditions, loved ones struggling with complex medical needs, and other vulnerable Americans should have access to high-quality and affordable coverage options. ...[W]e believe states and individuals should have better tools, resources, and flexibility to find solutions that fit their unique needs." (A Better Way to Fix Health Care, Page 5)
Over the past several days, some have suggested the Better Way proposal never intended to repeal Obamacare's community rating provision. They argue that many Republicans have promised to ensure that Obamacare is replaced with conservative solutions to protect the most vulnerable while preserving a functional insurance market. But their conflation of this general promise with a pledge not to repeal Obamacare rules like community rating is disingenuous.
The Speaker routinely cites a bill introduced by now-Secretary Tom Price as an example of the type of bill conservative lawmakers have previously supported. He construes their support for this bill as implicit support for community rating. But the Price bill could not have been clearer:
From Empowering Patients First Act: SEC. 3. NO MANDATE OF GUARANTEED ISSUE OR COMMUNITY RATING. Nothing in this Act shall be construed to provide a mandate for guaranteed issue or community rating in the private insurance market. (H.R. 2300, Page 5)
The Better Way proposal routinely implies that Obamacare's community rating provision will be repealed and then replaced with a continuous coverage protection long favored by conservatives. Such protection does not make sense—protection against what?—unless community rating is repealed. The poorly conceived, mandatory 30 percent continuous coverage surcharge proposed by the AHCA is a direct result of the bill's failure to do what was clearly implied in Better Way: eliminate federal community rating.
From Better Way Proposal: "Our plan also proposes a new patient protection for those Americans who maintain continuous coverage. Already in place for the employer market, this protection would apply to those in the individual market as well. This is how it works: If an individual experiences a qualifying life event, he or she would not be charged more than standard rates - even if he or she is dealing with a serious medical issue. This new safeguard applies to everyone who remains enrolled in a health insurance plan, whether the individual is switching from employer-based health care to the individual market, or within the individual market." (Page 20)
The Better Way proposal makes clear the financial support for high-risk pools will be available for individuals who are priced out of coverage, which can only happen if insurance companies are allowed to underwrite health status. Underwriting health status is currently prohibited by Obamacare's community rating provision and thus would need to be repealed.
From Better Way Proposal: Another Republican solution to help states increase the number of patients with health coverage is through robust high-risk pools. High-risk pools give financial support for those who find themselves priced out of coverage, helping ensure all Americans have access to affordable health care." (Page 21)
The Better Way proposal's open enrollment section also makes clear that should individuals not enroll, they could be subject to "higher health insurance coverage costs" in the future. Obamacare's community rating provision would not allow an individual to be charged more "regardless of how sick or healthy they are."
From Better Way Proposal: "Under current law, many patients are still struggling to get and keep health coverage. Our plan provides a onetime open enrollment period for individuals to join the health care market if they are uninsured, regardless of how sick or healthy they are. This fairness tool would give uninsured patients the same plan options as individuals who have previously entered the health care market. If someone chooses not to enroll during this one-time open enrollment period, the individual can get coverage at another time. However, making the decision to forego coverage during this one-time open enrollment period will result in the forfeiture of continuous coverage protections and lead to higher health insurance coverage costs for that individual for a period in the future." (Page 22)
Conservatives have long argued that it is possible to protect people who do the responsible thing and maintain continuous insurance coverage from higher premiums as well as coverage exclusions or denials through well-crafted continuous coverage protections. And it is possible to help the hardest cases through high risk pools, as the House now seems inclined to do. But such protections must be built atop a functional insurance market. That cannot happen with Obamacare's regulations on the books. Fortunately, the summary document for A Better Way to Fix Health Care made clear Republicans wanted a new foundation:
"Obamacare is making things worse by the day. It drives up premiums and deductible costs for individuals, families, and businesses. It forces people off the plans they like. It fuels waste, fraud, and abuse. And it cannot be fixed. Its knot of regulations, taxes, and mandates cannot be untangled. Obamacare must be fully repealed so we can start over and take a new approach."