An amendment to the House Republican health care bill is an effort toward satisfying the wish list of conservatives, though many are still pushing for outright repeal of the Affordable Care Act.
The amendment was published last week after a study was released by the Heritage Foundation calling for waivers to allow states to decide on benefit mandates and other provisions of Obamacare.
Co-author Ed Haislmaier, senior research fellow in health policy at the Heritage Foundation, said the amendment is in the ball park of what conservatives are looking for. "We want to repeal but understand why they are doing the waiver approach," Haislmaier told Patient Daily.
It is not clear whether the amendment will bridge the gap between the Freedom Caucus and more moderate Republicans, with some already expressing concern it will allow for the introduction by the back door of discrimination due to pre-existing conditions.
"And the Senate version may not end up in the same form," Haislmaier said. "That is act two. This is by no means the end of the process and we will see what happens in the Senate. But it has set some of the parameters. It is moving in a positive direction."
Haislmaier argued that a large part of the debate has been that something is going to be taken away but that "for a lot of folks it has been pain and no gain and they want relief from higher premiums."
In the study, Haislmaier and Heritage Foundation data analyst Drew Gonshorowski argued that it was a top priority to restore to states the authority to regulate insurance markets.
"Whether by outright repeal or by waiver, states should be freed from Obamacare’s benefit mandates, the minimum actuarial value requirement, and age-rating restrictions as soon as possible," the authors wrote.
The amendment, introduced by U.S. Rep. Tom MacArthur (R-NJ), who is regarded as being on the moderate wing among House Republicans, will allow states to apply for waivers on essential benefits, the age rating ratio and community rating.
Obamacare has a list of essential benefits that must be covered by insurers, including doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, and mental health services. States would be allowed to draw up their own list.
States would also be allowed to set their own age rating ratio higher than the 5-1 already in the Republican American Health Care Act. The ACA bars insurers charging older people more than three times their younger customers.
The bill explicitly states insurers cannot use pre-existing conditions to deny insurance. But the waiver on community rating, which essentially bars insurers charging different rates within a geographical area based on the health status of an individual, troubles some critics.
This waiver, according to critics, including among House Republicans, could allow insurers to charge prohibitively expensive premiums based on pre-existing conditions. Supporters say high risk pools will cover the most sick.
"We need to protect the most vulnerable people in the current plan," MacArthur told CNN following the publication of the amendment. "These are people with pre-existing conditions. We want to make sure they are protected."
Under the amendment, waivers would be automatically approved by Health and Human Services unless they were disapproved within 60 days for noncompliance with the requirements of the statute.