Congress

Democrats and Republicans clash over health care goals in Ways and Means

In between partisan comments, lawmakers mentioned health policies the panel could consider this year

Chairman Richard Neal, D-Mass., and ranking member Kevin Brady, R-Texas, talk during the House Ways and Means Committee organizational meeting for the 116th Congress on Thursday, Jan. 24, 2019. (Bill Clark/CQ Roll Call)

House Ways and Means Committee members hinted at health policy areas that could earn their attention this year during a Tuesday hearing on pre-existing conditions protections, but past disagreements will be difficult to move beyond if the meeting was any indication.

Essentially every committee Republican expressed support for guaranteeing coverage for people with pre-existing conditions and called on Congress to lower health care costs.

Democrats on the panel pushed back on that, criticizing Republicans for a previous lack of support for pre-existing conditions protections that were in the 2010 health care law.

In between partisan comments, lawmakers mentioned health policies the panel could consider this year. Those include efforts to lower health care costs, improve association health plans or allow people to buy into the Medicare program.

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Still, the hearing largely fell into a rehashing of past health care debates, such as how the 2010 health care law was drafted and whether the Republican health bill that passed the House last year included significant protections for patients with pre-existing conditions.

That measure included a provision known as the “MacArthur amendment” that was crucial to its passage in the House and would have allowed states to seek waivers letting insurers charge people with pre-existing conditions more for coverage in some situations.

Rep. Tom Reed, R-N.Y., said Republicans had heard the message from Americans during the 2018 election that the pre-existing conditions protections are important and said Democrats should stop suggesting otherwise.

“Take yes for an answer. We agree with you,” Reed said. “We heard the voice and the fear that was the result of the 2018 election where this issue became centerpiece.”

With that, Republicans showed how they hope to move the discussion toward how to lower health care costs.

“The ACA is failing too many Americans who face soaring costs, skyrocketing deductibles and few choices of local doctors and hospitals,” ranking member Kevin Brady, R-Texas, said, referring to the 2010 law. “It’s time for a fresh start, this time with both parties working together — creating truly affordable health focused on patients, not Washington.”

Brady had told reporters the day before that he thought the panel could work on efforts to lower prescription drug costs, prevent surprise medical billing and reduce deductibles in a bipartisan way.

Democrats hoped the hearing would be an opportunity for them to focus on the themes that helped them win the House majority during last year’s midterm election. Some sought to affirm those protections by citing personal anecdotes about patients who had been denied care because of pre-existing conditions or hitting annual spending caps before the implementation of the 2010 law.

Rep. Lloyd Doggett, D-Texas, criticized the Trump administration for declining to defend the health law’s pre-existing conditions provisions in a lawsuit brought by conservative state attorneys general to overhaul the health law, and said congressional Republicans were late to express their support for pre-existing conditions protection.

“It’s great to hear that they want to work with us, and I hope that they do, in moving to a better place and correcting some of the obvious deficiencies of the Affordable Care Act, but it would be even better had they advanced a comprehensive replacement, if they had one, for a vote and action over the course of the last eight years,” he said.

Rep. John Larson, D-Conn., said that if Republicans support pre-existing conditions protections, it could be a chance to refocus on the nation’s health care system infrastructure.

“We should therefore all be able to reach a conclusion rather quickly,” he said of pre-existing conditions. “What we have here is an infrastructure problem.”

Democrats and Republicans alike were interested to hear how association health plans could be an option for people who don’t qualify for subsidies to purchase plans on the exchanges to get comprehensive coverage.

Rob Robertson, the chief administrator of the Nebraska Farm Bureau, which has implemented an association health plan, testified about the importance of sharing risk to cover association health plans. He noted the group’s association health plan was compliant with the 2010 law, which earned nods from Democrats.

America’s Health Insurance Plans, a trade group representing insurance plans, said in written testimony that affordable coverage for everyone, including people with pre-existing conditions, requires full participation in the marketplace.

Another witness discussed the benefits of having most of the population covered.

“Pooling itself doesn’t make insurance cheaper. It just sort of spreads out the cost,” said Karen Pollitz, a senior fellow the Kaiser Family Foundation, who testified before the panel.

Democrats also criticized steps taken by the Trump administration to slash the budget for the navigator program that helps people sign up for insurance coverage and to expand short-term insurance plans, which do not have to comply with all of the law’s regulations, including guaranteeing coverage for pre-existing conditions.

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