Tiberi Responds to Letter from OPHA

Congressman Pat Tiberi has responded to a letter from our Executive Director Lois Hall regarding the American Health Care Act. In it, he states that he believes that “Americans deserve a better healthcare system that puts their needs first and provides better access to the tools that put them in charge of their own care.” 

He also emphasizes that “anyone who does not have a lapse in health insurance coverage for more than 63 consecutive days cannot be charged higher premiums, no matter what.”

He notes that “Without younger, healthier people in the market, without providers offering healthcare services, and without insurers offering coverage, the Obamacare exchanges are failing-and it is only going to get worse.”

The full letter follows:

Dear Ms. Hall,

Thank you for your recent communication regarding healthcare reform. In addition, thank you for your kind words. I appreciate this opportunity to correspond with you.

As you may know, House Republicans released the American Health Care Act (AHCA) on March 6, 2017. This legislation is a culmination of healthcare priorities and reforms that Congress has been discussing for years to repeal and replace the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare. The American Health Care Act would lower the cost of healthcare, deliver more choices to consumers, and provide greater flexibility to individuals, states, providers, and job creators. This bill would expand access to Health Savings Accounts and would also provide $100 billion for the newly established Patient and State Stability Fund directed to states to help lower the cost of care for patients, $15 billion specifically to help consumers pay for mental health, substance abuse, and maternity coverage, and $15 billion for a new Federal Risk Sharing Program to further assist patients with healthcare costs. The American Health Care Act passed the U.S. House of Representatives on Thursday, May 4, 2017 by a vote of 217-213 with my support and now awaits consideration in the U.S. Senate.

As the Senate considers reforms in AHCA, I remain committed to reforming our healthcare system. Since Obamacare became law in 2010, I’ve heard from many constituents about their rising healthcare costs or sudden drop in coverage. I’ve also heard from small business owners who have been burdened with excessive administrative tasks and are unable to hire new workers as a result of Obamacare’s mandates. In Ohio, we are experiencing double-digit premium hikes, our co-op health program collapsed and 20 of our counties only have one insurance company participating in the exchanges this year.

These problems aren’t unique to our state. Health insurers that have participated in the individual marketplace have faced aggregate losses of over $3 billion since the exchanges opened in 2014. This is in part because younger, healthy Americans are choosing the individual mandate tax penalty instead of an exchange plan with expensive premiums and coverage that doesn’t fit their needs. Almost half of those taxpayers who paid the tax penalty were under age 35 for 2014. Additionally, 34 percent fewer doctors and providers accept insurance from the Obamacare exchange compared to private insurance. Without younger, healthier people in the market, without providers offering healthcare services, and without insurers offering coverage, the Obamacare exchanges are failing-and it is only going to get worse. The AHCA aims to remedy these problems by taking steps to stabilize the markets, implementing an advanceable, refundable tax credit to help consumers in the individual market pay for their health insurance premiums, and giving consumers greater flexibility in the plans they choose.

The American Health Care Act includes many policies that have passed the House of Representatives over the past several years. Specifically, this legislation includes 31 bills that have passed the full U.S. House of Representatives. Congress has held more than 200 hearings on repealing and replacing Obamacare since 2011. The Ways and Means Committee, of which I’m a member, has held 37 bipartisan hearings to examine the tax treatment of healthcare and the individual mandate. As the Health Subcommittee Chairman of the Ways and Means Committee, I held a hearing last year where the committee heard from several Members of Congress about their proposals for improving our healthcare system.

It is important to note that this legislation maintains insurance protections for patients such as allowing dependents to stay on their parents’ plan until age 26, prohibiting insurance companies from denying patients coverage due to a preexisting condition, and preserving the ban on lifetime caps for coverage.. Congressman Tom MacArthur (R-N.J.) offered an amendment to the AHCA that would allow states to submit an application to the Department of Health and Human Services (HHS) to waive the following: federally mandated essential health benefits, the age rating component of community rating requirements, and the health status component of community rating requirements. States would have to specify how they would reduce premiums, stabilize the market, increase enrollment and choice, or stabilize premiums for those with preexisting conditions. This amendment would not allow insurers to rate based on gender or deny coverage to anyone, even if they have a preexisting condition.

Beginning in 2019, the MacArthur amendment would allow insurers to account health status when determining patients’ premiums in very limited circumstances. Insurers may consider health status only if the following requirements are met: a state applies for such waiver and it is approved by HHS, the consumer is purchasing coverage on the individual market, and the consumer did not maintain coverage for longer than 63 days. To reiterate, anyone who does not have a lapse in health insurance coverage for more than 63 consecutive days cannot be charged higher premiums, no matter what. This is to encourage people to sign up for and maintain health insurance coverage, instead of waiting until they are sick or need care to do so, which makes healthcare more expensive for everyone.

If a consumer does have a lapse in coverage for more than 62 days, insurers may only account health status for a consumer’s insurance for one plan year. In addition, the state must establish a program for high-risk individuals and premium stabilization through the Patient and State Stability Fund. Furthermore, the AHCA provides an additional $8 billion specifically for these consumers who live in a state with a waiver and may have a rise in premiums due to a lapse in coverage and may need financial assistance with their premiums. This legislation does not define a list of health statuses that qualify as preexisting conditions and does not discriminate based on race or gender.

I’ve heard growing concerns from constituents that Members of Congress and their staffs would be exempt from the MacArthur amendment. It is important to clarify that nothing in the underlying bill or the amendment changes how Members of Congress and their staffs must purchase coverage in the exchanges as required under Obamacare. The House of Representatives passed H.R. 2192 just before voting on the American Health Care Act. H.R. 2192, introduced by Congresswoman Martha McSally (R-AZ) on April 27, 2017, would explicitly prevent Members of Congress and their staffs from being exempt from the MacArthur amendment. This bill passed by a vote of 429-0, and I am an original cosponsor.

Passing the American Health Care Act is another step in the legislative process in order for a bill to become law. As the U.S. Senate considers this legislation, the non-partisan Congressional Budget Office (CBO) will continue to review recent changes made to the bill. It was not ideal to vote on the AHCA without a full CBO score of the new amendments. However, the CBO released a report on the vast majority of the legislation on March 13, 2017, and I believe the additional funds and flexibility for states will further lower premiums for Americans. The CBO score also does not reflect other steps we can take at the administrative level and with additional legislation to stabilize the health care market, boost competition, and lower costs.

Over the past several years, I’ve met with constituents who have shared their personal experiences with the Affordable Care Act – both positive and negative experiences. Leading up to the vote on AHCA, I held two telephone town halls with thousands on constituents, had over 20 hours of meetings in my Ohio office and spoke about healthcare in many roundtables and events around Ohio’s 12th District.. I believe that Americans deserve a better healthcare system that puts their needs first and provides better access to the tools that put them in charge of their own care. Since the AHCA now awaits consideration in the U.S. Senate, I would encourage you to contact Senator Brown and Senator Portman’s office. You can reach Senator Portman’s office at 202-224-3353 and Senator Brown’s office at 202-224-2315.

I will be sure to keep your thoughts in mind as we continue the discussion on healthcare reform. Thank you again for taking the time to contact me. Should you need further assistance, please don’t hesitate to contact my office.

Patrick J. Tiberi
Representative to Congress