Factcheck and Expert Response On Background:

MacArthur has said his amendment would “guarantee coverage for pre-existing conditions,” but health policy experts say that although the MacArthur amendment did not end guaranteed issue, the provision requiring insurers to offer coverage to individuals with preexisting conditions, its waivers for states that create high risk pools would have made that coverage so unaffordable for people with preexisting conditions that they would be effectively – but not letter-of-the-law explicitly – locked out of the insurance market.

Politifact:

MacArthur’s claim that his bill guaranteed coverage for pre-existing conditions was debunked by Politifact as “Mostly False” over a year ago. The MacArthur Amendment would eliminate nationwide protections for people with pre-existing conditions, and restore the pre-ACA rules.

According to an expert speaking with Politifact, “Health status underwriting is literally charging a higher (possibly much, unaffordably, higher) premium to people with pre-existing conditions…Under the MacArthur amendment, they could not be refused coverage, but insurers could impose high enough premiums that coverage would be unaffordable.”

American Medical Association:

The American Medical Association also blasted MacArthur’s Amendment, saying it would “make coverage unaffordable for people with pre-existing conditions.”

“The current ban on health status underwriting protects individuals from being discriminated against by virtue of their medical conditions.  Prior to the passage of the ACA, such individuals were routinely denied coverage and/or priced out of affordable coverage. We are particularly concerned about allowing states to waive this requirement because it will likely lead to patients losing their coverage.  Although the MacArthur Amendment states that the ban on preexisting conditions remains intact, this assurance may be illusory as health status underwriting could effectively make coverage completely unaffordable to people with preexisting conditions.”

American Heart Association

In a combined statement with seven other patient advocacy organizations, The American Heart Association also weighed in on MacArthur false claim:

“There is no substitute for fundamental, unequivocal protections for people with pre-existing conditions.”

Additional Coverage of MacArthur Amendment:

Los Angeles Times: MacArthur Amendment “Would Effectively End Obamacare’s Guarantee Of Insurance Coverage For Those With Preexisting Conditions.” “Of particular concern is that this latest version of the bill contains a provision, added to attract votes from conservatives, that would effectively end Obamacare’s guarantee of insurance coverage for those with preexisting conditions. States could allow insurers to charge sick people more and offer them coverage through so-called high-risk pools, which many states operated before Obamacare. But experts and consumer advocates panned this arrangement as unaffordable.” [Los Angeles Times, 5/2/17]

ABC News: MacArthur Amendment Would “Effectively Undermine Obamacare’s Protections For People With Pre-Existing Conditions.” “The amendment to the current GOP health care plan would effectively undermine Obamacare’s protections for people with pre-existing conditions, allowing states to apply for a waiver from national pre-existing conditions rules.” [ABC News, 5/2/17]

Politico: Republicans’ Bill Would “Weaken The Affordable Care Act’s Pre-Existing Conditions Protections.” “Republicans’ bill would weaken the Affordable Care Act’s pre-existing conditions protections, which could affect tens of millions of Americans.” [Politico, 5/2/17]

NPR: New GOP Health Proposal Could Ditch Protections For People Who Are Sick [NPR, 4/20/17]

CNN: GOP looks to weaken pre-existing condition guarantee [CNN, 4/25/17]

New York Times: Republican Health Proposal Would Undermine Coverage for Pre-existing Conditions [New York Times, 4/4/17]

New York Times: Proposal To Allow States To Opt Out Of Essential Health Benefit And Community Rating Provisions “Would Effectively Cast The Affordable Care Act’s Pre-Existing Conditions Provision Aside.” “Late Monday night, word emerged that the White House and the group of conservative lawmakers known as the Freedom Caucus had discussed a proposal to revive the bill. But the proposed changes would effectively cast the Affordable Care Act’s pre-existing conditions provision aside. The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.” [New York Times, 4/4/17]

New York Times: “The Ability To Opt Out Of The Benefit Requirements Could Substantially Reduce The Value Of Insurance On The Market.” “The ability to opt out of the benefit requirements could substantially reduce the value of insurance on the market. A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs.” [New York Times, 4/4/17]

New York Times: The Ability To Opt Out Of Community Rating Provision “Would Make The Insurance Options For Those With Pre-Existing Conditions Even More Meaningless.” “The second opt-out would make the insurance options for those with pre-existing conditions even more meaningless. Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted. If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.” [New York Times, 4/4/17]

New York Times: “The Result Could Be A World Where People With Pre-Existing Conditions Would Struggle To Buy Comprehensive Health Insurance.” “Mr. Meadows said that the proposal presented to the Freedom Caucus would retain the pre-existing conditions policy. But that would be true in only the most literal sense. The mix of policies could allow insurance companies to charge sick people prices that few of them could pay. And it could allow them to exclude benefits that many healthy people need when they get sick. The result could be a world where people with pre-existing conditions would struggle to buy comprehensive health insurance — just like before Obamacare.” [New York Times, 4/4/17]

Bloomberg: Waivers For Essential Health Benefits And Community Rating “Would Allow Insurers To Charge Sick People More For Coverage.” “Lawmakers have discussed allowing states to apply for waivers on some of Obamacare’s requirements, including coverage of essential health benefits and the community rating system, which prevents insurers from varying premiums within a geographic area based on certain factors, including health status. Such a change would allow insurers to charge sick people more for coverage, although Meadows said the Freedom Caucus wants to maintain the current law’s protection for coverage of people with pre-existing conditions.” [Bloomberg, 4/6/17]

Politifact: Under AHCA, “Insurers Would Be Able To Charge People Significantly More If They Had A Pre-Existing Condition… Possibly Requiring People To Pay Thousands Of Dollars Extra Every Year…” “Pittenger said that the Republican AHCA health care plan ‘does not eliminate protections for pre-existing conditions.’ While insurers technically would still be required to offer coverage to people with pre-existing conditions, the AHCA would weaken protections for those people. Insurers would be able to charge people significantly more if they had a pre-existing condition like heart disease, cancer, diabetes or arthritis – possibly requiring people to pay thousands of dollars extra every year to remain insured. We rate this claim Mostly False.” [Politifact, 5/4/17]

New York Times: “With A Waiver, States Could Permit Insurers To Charge Higher Premiums Based On The “Health Status” Of A Person Who Had Experienced A Gap In Coverage.” “At the heart of the debate is an amendment to the repeal bill proposed by Representative Tom MacArthur, Republican of New Jersey. The amendment, which won over the Freedom Caucus last week, would give state governments the ability to apply for waivers from the existing law’s required “essential health benefits,” such as maternity, mental health and emergency care, and from rules that generally mandate the same insurance rates for people of the same age, regardless of their medical conditions. With a waiver, states could permit insurers to charge higher premiums based on the “health status” of a person who had experienced a gap in coverage. To qualify for a waiver, a state would have to have an alternative mechanism, like a high-risk pool or a reinsurance program, to provide or subsidize coverage for people with serious illnesses.” [New York Times, 5/2/17]

Washington Post: Waiver For Community Rating Would “Would Smack [People With Pre-existing Conditions] With Far More In Costs — Potentially Pushing Them Off Coverage Entirely.” “In effect, the waiver on preexisting conditions is designed to make conservatives happy, while giving moderates high-risk pools that allow them to argue it wouldn’t harm people with preexisting conditions. The restoration of EHBs is designed to make moderates happy, while telling conservatives states could still get out from under them. But the waiver on prohibitions against jacking up premiums for people with preexisting conditions — which is called “community rating” — is a major problem. It would smack them with far more in costs — potentially pushing them off coverage entirely.” [Washington Post, 4/20/17]

Huffington Post: While Republicans Claimed The MacArthur Amendment Would Protect People With Pre-existing Conditions, “The Reality, However, Is That Insurers Would Be Able To Effectively Deny Coverage By Pricing Sick People Out Of The Market.” “Leadership is expected to discuss the amendment on a conference call this Saturday with GOP members, but public opinion might also affect the landscape. Republicans are trying to say their amendment will cover people with pre-existing conditions ― because, first, the legislation still claims those people can’t be denied coverage, and second, because there will be high-risk pools for those people if insurance costs dramatically go up for them. The reality, however, is that insurers would be able to effectively deny coverage by pricing sick people out of the market.” [Huffington Post, 4/19/17]