The MacArthur Amendment gets a thumb down. The latest round of the American Health Care Act (AHCA) includes an amendment – the MacArthur Amendment and it’s bad news for those with diabetes.

DPAC has given insight in previous blog posts why the proposed “repeal and replace” for the Affordable Care Act (ACA) will negatively impact many in the diabetes community. The addition to the AHCA, written by Representative Tom MacArthur (R-NJ), gives the far right Republican conservative groups (The Freedom Caucus) concessions to influence their support of the revised bill. Unfortunately, it strips the pre-existing condition protections that the ACA – not at a federal level, but at the state level.

Essential Health Benefits no longer essential.

Essential Benefits MacArthur AmendmentThe Essential Health Benefits (which are benefits that must be included in health-insurance plans under ACA) can be manipulated at the state level. Each state can choose what are “essential” benefits if it shows the premium pricing for insurance plans could decrease overall. Pregnancy coverage? No longer essential. Emergency room coverage? No longer essential. Presciption coverage? No longer essential.

People with preexisting conditions like diabetes may find that their health insurance may cost less… but cover nothing they need to stay healthy.

Community-rating rules can be waived.

The “level playing field” for anyone looking to purchase insurance will no longer be required. Currently, under ACA, insurers are required to charge the same price regardless of gender or preexisting condition. The MacArthur Amendments allows states to request a “Limited Waiver” by providing

The “level playing field” for anyone looking to purchase insurance will no longer be required. Currently, under ACA, insurers are required to charge the same price regardless of gender or preexisting condition. The MacArthur Amendments allows states to request a “Limited Waiver” by providing fund for people with diabetes and other conditions to get coverage, mostly through the “high-risk pools” (which have been shown to fail consistently on a state level). The written proposal states that states cannot limit access, but makes no regulation or condition on the funding to assist those with preexisting conditions.

Those with diabetes, while not denied coverage, could be faced with higher premiums simply because of the condition. We lose the protection for preexisting condition guaranteed under ACA – and in doing so, face uncertainty on whether we could afford the new premiums offered to us.

Limited Waiver can be rubber stamped.

MacArthur Amendment rubber stampThe “Limited Waiver” requested by states are being reviewed by the Department of Health and Human Services, allowing the new administration to rubber stamp these waivers. As we understand, there is no reason for HHS to deny a limited waiver to any state requesting one unless they do not meet requirements. What are the requirements?

  • Be submitted in the time and manner required by HHS;
  • Describe how the waiver would:
    • Reduce average premiums for health insurance coverage in the state;
    • Increase insurance enrollment;
    • Stabilize the market for insurance coverage;
    • Stabilize premiums for people with preexisting coverage; or
    • Increase the choice of health plans in the state;
  • Specify the period for which the waiver would be effective (which could not be more than 10 years unless an extension were granted by HHS);
  • Specify the higher age ratio that the state intends to allow;
  • Specify the essential health benefits the state intends to require; and
  • If the state allows health status underwriting for people who fail to maintain continuous coverage, demonstrate that it has a program in place that meets the requirements described above, which must remain in place for the duration of the waiver.

Good Enough for the U.S. Public, But Not Good Enough For Congress

The MacArthur Amendment of the American Health Care Act (AHCA) has an interesting twist: it doesn’t apply to members of Congress or their aides. This was confirmed by a spokesperson for Rep. Tom MacArthur:

Members of Congress and their staff would get the guarantee of keeping these Obamacare regulations.

Vox was the first to share news of this convenient exemption for Congress.

The Obamacare section that requires legislators to buy on the marketplace is section 1312(d)(3)(D). And if you look at the Republican amendment, and the list of who cannot be included in this waiver? It includes Section 1312(d)(3)(D).

What can you do RIGHT NOW?

If you haven’t downloaded the DPAC mobile app, it’s time. You can tweet and call your senators and representatives to let them know that the MacArthur Amendment is not acceptable. They must reject the amendment and the American Health Care Act as it stands… as it will directly and negatively impact people with diabetes.

  1. Download the app.
  2. Tweet directly to your Congressional Senators and Representative.
  3. Call your Congressional Senators and Representative and let them know that you oppose the MacArthur Amendment and the current version of the American Health Care Act.
  4. Share this post to let others know about the MacArthur Amendment and the exclusion of Congress from being impacted by this proposal.

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