Another Day, Another $8 Billion for Pre-Existing Conditions

Republicans are adding another $8 billion over five years to their health bill to help Americans with pre-existing medical conditions pay for insurance, the latest such supplement designed to stop moderates and a few skeptical conservatives from bailing on the legislation.

The amendment brings Reps. Fred Upton and Billy Long, the two sponsors of the language, back to the "yes" column on the American Health Care Act, keeping the GOP within striking distance of preserving a slim majority of 216 votes for passage. Both lawmakers switched their votes to no earlier this week because of a House Freedom Caucus-favored amendment that allows states to conditionally waive an Obamacare regulation prohibiting insurers on the individual market from charging consumers different premiums based on their health status. Upton and Long—with some fellow GOP members and the entire Democratic caucus—feared the policy would eliminate protections for individuals with pre-existing conditions, since undoing the Obamacare mandate would allow insurers to charge such people higher premiums.

The Upton-Long amendment contains money to limit the cost ultimately borne by plan-holders. Specifically, the House Energy and Commerce Committee spokeswoman told THE WEEKLY STANDARD it would apply to waiver-state consumers with pre-existing conditions who have not maintained "continuous coverage" for a certain period. The Republican legislation penalizes insurance applicants who went longer than 63 days without insurance in the previous year. The amendment's text was still reportedly a work in progress during the morning, and neither it nor a summary had been made public as of press time.

Many health experts and commentators said the idea was significantly underfunded. "Spread over five years," $8 billion is "a fifth of a pittance," economist Robert Graboyes of the conservative Mercatus Center at George Mason University told The Hill. Former Obama administration auto czar Steven Rattner cited a report from the progressive Center for American Progress that estimated the risk pools already contained in the GOP bill faced a $20 billion annual shortfall. The committee did not immediately respond to a request for comment on these criticisms.

The AHCA has been updated twice now to address the pre-existing conditions issue. The first version of the measure contained $100 billion over nine years for state funds that could be used, among other purposes, to help individuals with such health status. Then, as a complement to the Freedom Caucus-backed amendment, Republicans adopted a $15 billion "invisible risk-sharing" program for an extra boost to people on the individual market with pre-existing conditions. The latest change seems to concern the same people, with the added specification that they owe a penalty for not having maintained continuous coverage. With the original bill and the changes to it having been introduced in a matter of weeks, there is a paucity of analysis of how effective the pre-existing conditions subsidies would be.