Amendments to a Republican health care bill are "a good step forward in the conservative effort to repeal the Affordable Care Act," according to a health care policy expert.
But this is a dynamic situation and changes are likely in the Senate after it passed the House, said Lanhee Chen, a research fellow with the Hoover Institution at Stanford University in California.
"There will be more discussion and it will evolve as the bill gets to the Senate," Chen told Patient Daily. On Thursday, the House voted 217-213 in favor of the American Health Care Act, which includes amendments added after the initial bill failed to garner enough support for it to pass in March.
Senate Republicans admit there will be difficulties when the bill moves to that chamber. Critics, including Republicans, cite the provision allowing state waivers on community rating as a major stumbling block.
The waiver will allow insurers to charge different prices based on the health status of an individual, including if they have a pre-existing condition. Supporters of the act claim high-risk pools and reinsurance programs will cover those individuals.
“When they send it over here, it’ll be a real big challenge on the Senate side, as well, and you’ll have an opportunity to file lots of stories about the discussions as we move toward trying to achieve that,” Senate Majority Leader Mitch McConnell (R-KY) said this week, according to a Washington Post report.
Chen believes the bill, including the amendments, is a positive move for those working to repeal and replace the Affordable Care Act, also called Obamacare.
"It needs to be cured and this is a good start." Chen said. However, he hopes the Senate will consider increasing the level of tax credits available, give more to older beneficiaries, and make changes that would result in a "gentler transition" on Medicaid. Under the bill, the numbers covered by Medicaid will be radically reduced.
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 under the new act.
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 House Republicans, could allow insurers to charge prohibitively expensive premiums based on pre-existing conditions.
"We need to protect the most vulnerable people in the current plan," Rep. Tom MacArthur (R-NJ) 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 the U.S. Department of Health and Human Services unless they were disapproved within 60 days for noncompliance with the requirements of the statute.
Chen believes the administration will enforce the requirement that a state has some contingency "whether a state-based high-risk pool or reinsurance mechanism, or participation in the federal invisible high risk pool arrangement."
"So I don't see this as a problem or issue in the same way that opponents of the AHCA might," he said.