A Republican congressman is taking another swing at overhauling Obamacare even as most members of the party have set their sights on reforming other areas of healthcare.
Rep. Bruce Westerman, R-Ark., will be introducing a bill Tuesday that pulls from different healthcare bills that lawmakers have weighed in the last two years, from the failed GOP “repeal and replace” bill to the foundered Senate bipartisan Obamacare stabilization package. It also keeps a good portion of Obamacare in place and codifies healthcare provisions the Trump administration has authorized through rulemaking.
The details of the bill, known as the Fair Care Act, suggest that Westerman is trying to grapple with the reality that Obamacare is unlikely to be repealed and looking at ways to make it more conservative. Westerman said he hopes he can bring more Republicans on board even though many of them have moved on from the issue and are focused instead on tackling healthcare costs.
“Healthcare is still a huge issue,” said Westerman, who started working on the Fair Care Act one week after the Senate failed to repeal Obamacare in a dramatic late-night vote in 2017. “Just because our healthcare bill fell in that infamous vote in the Senate doesn’t mean the healthcare issue has gone away.”
Westerman said that he doesn’t want to place a label on his bill — it’s not Obama “repeal and replace,” nor is it an “Obamacare fix.”
“It’s a fair approach to healthcare, and if it keeps portions of the Affordable Care Act that are good, I’m good with that,” he said, using the formal name for Obamacare.
Westerman’s plan would keep the Obamacare exchanges, through which people buy private health insurance. And it would provide for states to expand the exchanges so that low-income people currently on Medicaid who do not have a disability will also use the private market. That change would be achieved by letting states take Medicaid as a block grant and using that money to pay to subsidize people on the exchange.
Westerman also wants to give states the option to hold open enrollment periods every two or three years rather than every year. That way, lower premiums could be locked in for longer and people would remain on their health plan, he said.
“We want to take the things that are working and can be improved and keep the stuff that is good for consumers,” Westerman said.
The bill would also reauthorize cost-sharing reduction subsidies Trump ended in 2017 that help pay for out-of-pocket medical expenses for low-income people and estate “copper plans” that have low premiums and higher deductibles. Both provisions were part of the stabilization efforts the Senate had worked on.
The Fair Care Act would repeal a mandate that employees must offer health insurance to their workers as well as a slew of Obamacare taxes on health insurance. On Medicare, the bill would end eligibility for programs that cover hospital and doctor care, as well as prescription drugs, for people who have lifetime earnings of more than $10 million, a move Westerman said is aimed at helping Medicare remain sustainable in the long term.
The bill would codify rules the Trump administration posted that allow people to band together to buy coverage in the same way larger insurers do and that allow people to buy coverage outside of Obamacare’s rules, known as short-term plans, for at least a year.
Allowing short term plans cuts against Westerman’s claim that his bill keeps protections for pre-existing conditions in place, because short-term plans are narrow plans meant to address catastrophic situations and do not cover ongoing medical conditions. For instance, under a short-term plan a person with diabetes would not be covered for insulin, and someone with a history of cancer could be turned away.
Short-term plans were initially allowed under former President Barack Obama but were shortened to a three-month limit so more people would sign up for Obamacare, which provides more robust coverage but is also more expensive for people who don’t receive subsidies.
To help lower the cost of premiums for people in the exchange, the Fair Care Act would allocate $200 billion over 10 years to an “invisible” high-risk pool reinsurance program that states could ask to use. The program allows the government to reimburse health insurers for covering sicker patients. The term “invisible” is used in the arrangement because enrollees don’t know when they are designated as high-cost patients. It’s a conservative-preferred way to provide coverage for people with pre-existing illnesses, rather than the Obamacare rules that result in higher premiums across the board for coverage.
Westerman is not on the committees that typically craft healthcare policy, such as Energy and Commerce or Ways and Means. He said he decided to work on the Fair Care Act because he felt a responsibility to look for ways to lower the cost of healthcare and to open the door to more people being covered by health insurance.
Bills addressing healthcare coverage are unlikely to advance under a Democratic-majority House and Republican-controlled Senate, but certain lawmakers have been looking to demonstrate where they stand on healthcare ahead of the 2020 elections. The bill also could set the groundwork for a Republican plan if Obamacare ultimately were to be ruled unconstitutional in court.
Republicans have largely moved past focusing on repealing Obamacare. Instead, they are working on bipartisan efforts to reduce what patients pay for drugs and to tackle surprise medical bills.
Democrats, meanwhile, have focused their messaging on expanding the government’s role in healthcare, whether by allowing people to buy into Medicare at a younger age or making the case for enrolling all people in the U.S. under a government healthcare system dubbed “Medicare for all.”
In rolling out his messaging around the GOP healthcare plan, Westerman will aim to highlight that it differs from the Democratic goal to create a fully government-financed healthcare system.
Of the Fair Care Act, he said, “What it definitely is not is a single-payer system that is on the table right now.”
