ACHA – Proposed Amendments Protect or Attack the Sick/Uninsured?

Let me preface this by saying that employer-based health coverage doesn’t really factor into the discussion below.  Again, the beef with the ACA right now is the tanking of the individual market and the Exchange.


House Republican leaders posted new ACHA language last week.  Referred to as the MacArthur amendment, it potentially weakens ACA consumer protections by delivering a one-two punch to people who fail to keep coverage in place or try to sign up after developing an illness or injury.


In short, the amendment allows for states to discontinue the ACA’s “community rating” rule. By circumventing “community rating”, insurance companies could base premiums on an individual’s health status.   Supporters of “community rating” and the ACA liked that it required all individual plan enrollees to pay the same rates regardless of health status. They claimed that it spread the higher medical cost of sick individuals equally among all enrollees.  Where it failed, however, is convincing the young and/or healthy to buy into the ACA and pay the high premiums to spread the risk among all enrollees.  And, thus began the death spiral of the Exchange and the ultimate failure of Obamacare.


Additionally, Republicans argue that coverage for those with medical conditions will be protected even under the MacArthur amendment. That’s because it waives consumer protections only in states that set up programs, such as high-risk pools, subsidies, or premium stabilization plans, to help cover people whose medical history could price them out of the insurance market.


On Monday the President said, without the slightest degree of circumspection, that the new bill being discussed will protect the sick.  Stating to Bloomberg News that “It will be every bit as good on pre-existing conditions as Obamacare.”


Strictly speaking as a health insurance expert, the key has always been to get coverage and keep it whether individual, employer-based or COBRA.  If you keep it current, you will not have to face pre-existing condition exclusions.


Stay tuned, I suspect we’ll get some feedback on the MacArthur Amendment by this Friday.

Posted in: Affordable Care Act

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  1. Carolyn May 4, 2017

    House passes ACA repeal in razor-thin Republican victory 5.4.17. Facing major opposition in the Senate.


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