Despite concerns over pre-existing conditions, Rep. Mike Coffman leaning yes on AHCA as vote looms

DENVER – U.S. Rep. Mike Coffman is leaning toward voting for a revived Republican plan to replace Obamacare, but says he wants to see more protection for pre-existing conditions or he’ll vote against sending the bill to the Senate.

President Donald Trump and several other House Republicans have again been trying to shore up votes this week in their ongoing effort to replace the Affordable Care Act.

Wednesday morning, those efforts grew further legs when Republican House members Fred Upton and Billy Long said they had flipped from “no” to “yes” on their plans to vote for the bill after the president accepted an amendment to the bill from Upton the Michigan Republican says will allay concerns over pre-existing condition coverage.

The bill would add $8 billion over five years to fund high-risk pools, according to multiple news outlets who had seen the amendment, which would be added to $130 billion already written into the bill.

The addition of the extra money still may be short of the money needed, according to some Republicans, who say high-risk pools would actually need between $150 and $200 billion.

Moderate and ultra-conservative Republicans, as well as Democrats, have voiced concern over the reinstatement of high-risk pools for pre-existing condition coverage under the AHCA – something Obamacare eliminated.

Last week, Coffman and his team said that the AHCA and MacArthur amendment that was added in recent weeks contained coverage for all pre-existing conditions, something House Speaker Paul Ryan reiterated, as did the president himself.

But some of the writers of Obamacare, as well as some in the health care and retirement industries, have said that even with the MacArthur amendment, people with pre-existing conditions could face not being able to afford coverage because companies and states would make it too expensive.

And though multiple requests for clarification on whether Coffman’s stance was made after the Upton amendment was introduced or before, it appears Coffman is close to supporting the measure as he said he would in March, despite ongoing pledges to protect Coloradans with pre-existing conditions.

“The current bill has a lot of strong elements – giving the states more flexibility is sound public policy…But we need to tighten some protections for those with preexisting conditions,” Coffman said in a back-and-forth statement Wednesday.

While saying there needed to be better protections for people with pre-existing conditions, he said that critics of the AHCA were being “totally disingenuous” about the reality of the bill’s language on them.

“I worry that, under the current language, a small percentage of those with preexisting conditions may not be adequately protected,” he said.

But the biggest sign that he was leaning toward a “yes” vote came with the final on-the-fence portion of Coffman’s statement:

“If House Leadership will work to tighten protections for those with preexisting conditions, I’m a yes on sending this bill to the Senate for further consideration. If not, I’m a no, and we’ll go back to the drawing board.”

Ken Buck, a Colorado Republican who is a member of the conservative Freedom Caucus, will support the bill, according to several whip counts, and other Freedom Caucus members who had been on the fence were moving toward supporting the bill Wednesday, according to reports.

Trump praised Buck for his support of the measure in late March.

Scott Tipton is “leaning yes,” according to a whip count from HuffPost’s Matt Fuller. He has also promised to protect people with pre-existing conditions under the AHCA.

But AARP, the Kaiser Family Foundation and several other national and state organizations have said the AHCA is bad for Americans, particularly those with pre-existing conditions. AARP called the Upton amendment to add $8 billion over five years a “giveaway to insurance companies” and said it “won’t help the majority of those with preexisting conditions.”

And the American Cancer Society, American Heart Association, American Diabetes Association and American Lung Association, among others, all came out Wednesday in opposition to the AHCA as it stands -- even with the MacArthur and Upton amendments.

"This bill, including the MacArthur and Upton Amendments, would undermine that vital safeguard [protecting against higher charges for pre-existing conditions]," their combined statement said. "The various patches offered by lawmakers -- including high-risk pools and financial assistance with premiums -- do not in any way offer the same level of protection provided in current law."

The American Medical Association on Wednesday also said the changes to the AHCA do not adequately cover people with pre-existing conditions.

“None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes,” said AMA President Andrew W. Gurman, M.D. “High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all.”

Colorado's past with high-risk pools

Colorado has experience with high-risk pools, as it had them from 1990 until 2014, when they were eliminated with the implementation of Connect for Health Colorado, the state health exchange operating under Obamacare.

Colorado was one of 35 states that offered high-risk pools, which are plans that cover people who can’t typically get health insurance – many of them because of their pre-existing conditions.

The state covers much of the funds for the pools through various fees, but insurance companies can raise prices so that state coverage won’t cover care beyond premiums. Federal subsidies also contributed to Colorado’s high-risk pools when they were in place under CoverColorado, the state high-risk pool program.

In 2009, the Colorado Legislative Council found there were around 9,200 people in the state covered through CoverColorado. The plans carried premium caps at 150 percent of standard rates and deductibles of between $1,000 and $5,000, with lifetime deductibles capped at $1 million.

But it found that high health care costs meant that premiums weren’t covering the full cost, despite close to 30 percent of low-income recipients receiving discounts on their premiums.

By the end of 2011, however, the number of Coloradans covered under high-risk pools was close to 14,000 – the sixth-most populous high-risk pool in the country. That accounted for 3.5 percent of the non-group market enrollment that year in the state.

Though many states’ high-risk pools excluded coverage for pre-existing condition for people otherwise eligible for coverage for between 6 and 12 months, Colorado was one of two states that only excluded coverage for the first three months.

And before the ACA effectively eliminated high-risk pools by forcing insurers to exempt pre-existing conditions when considering coverage, the list of pre-existing conditions that would not be covered in Colorado was extensive.

This was Anthem’s medical condition rejection list pre-Obamacare in Colorado:

The Congressional Budget Office has yet to score the revised AHCA, but said in its original analysis that 24 million fewer people would be insured in the next decade than would have been under Obamacare. It also said that the AHCA would have devastating effects on Medicaid across the country.

Colorado’s Medicaid program could suffer losses topping $10 billion, according to analysis.

The Colorado Consumer Health Initiative blasted the revised AHCA Wednesday.

“Coloradans have experience with high-risk pools from before the Affordable Care Act, and it doesn’t work,” said the organization’s spokesman, Adam Fox, saying Coffman has “flipflopped” on his stance to protect Coloradans with pre-existing conditions.

“An additional $8 billion doesn’t magically make high-risk pools work, and Coffman, as a fiscal conservative, should know better than to throw money at a failed idea,” Fox continued. “This isn’t what people in America or Colorado want. It is time for the GOP to drop this crazed fixation on repeal -- and move on.”

Late Wednesday, Ryan said the full House would vote on the AHCA on Thursday.


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