Read the GOP's new health care plan

The American Health Care Act (AHCA) as amended delivers relief from Obamacare’s taxes and mandates that have hurt job creators, increased premiums, and limited options for patients and health care providers. It returns control of health care from Washington back to the states and restores the free market so Americans can access quality, affordable health care options that are tailored to their needs.

Obamacare was based on a one-size-fits-all approach that put bureaucrats in Washington in charge of your health care. The law led to higher costs, fewer choices, and less access to the care people need.

The AHCA will deliver the control and choice individuals and families need to access health care that’s right for them. And provide the freedom and flexibility states, job creators, and health care providers need to deliver quality, affordable health care options.

The Upton-Long Amendment further strengthens the American Health Care Act’s (AHCA) protections for Americans with pre-existing conditions by providing an additional $8 billion in resources over 5 years to those with pre-existing conditions.

WHAT DOES THIS AMENDMENT DO? The Upton-Long amendment strengthens the AHCA by reaffirming our commitment to protect patients with pre-existing conditions.

HOW DOES IT WORK? It dedicates $8 billion solely to reduce premiums and other out-of-pocket costs for patients in the individual market with pre-existing conditions who do not maintain continuous coverage and who live in states that receive a waiver to redesign their insurance market.

HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? This $8 billion is on top of the $130 billion available to states through the AHCA’s Patient and State Stability Fund, which helps states repair their health markets damaged by Obamacare.

States can use the funds to:

cut out-of-pocket costs, like premiums and deductibles
promote access to preventive services, like getting an annual checkup, as well as dental and vision care
promote participation in private health insurance or to increase the number of options available through the market

Further, the AHCA provides a refundable tax credit to those without other health care options so they can get – and stay covered – before they face a serious medical event or suddenly fall ill. These combined resources reaffirm the commitment from House Republicans to ensure Americans with pre-existing conditions are protected.

The MacArthur Amendment keeps our promises of lowering costs and protecting high-risk patients by giving states greater flexibility and more control over local insurance markets.

WHAT DOES THIS AMENDMENT DO? The MacArthur Amendment provides states the option to apply for waivers from certain federal insurance regulations that increase insurance premiums. This new flexibility will allow states to design insurance frameworks that are right for their unique populations, providing superior care and lowering costs for patients.

HOW DOES IT WORK? Any states that apply for a waiver must attest that its purpose is to reduce the cost of health care or increase the number of people with health care coverage.

HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? The amendment’s limited waiver for health rating requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk-sharing program. No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected. In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.

Myth #1: This Amendment does not cover pre-existing conditions.

FACT: The MacArthur Amendment explicitly maintains protections for pre-existing conditions. NO STATE, under ANY circumstances, may ever obtain a waiver for guaranteed issue of coverage, guaranteed renewability of coverage, or the prohibition on denying coverage due to pre-existing conditions. The amendment specifically clarifies that its provisions cannot be construed as allowing insurers to limit coverage for those with pre-existing conditions. All of these protections will remain the law.

Myth #2: This Amendment will price those with pre-existing conditions out of the market, making health care unaffordable for them.

FACT: The amendment’s limited waiver for health rating requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk sharing program. No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected. In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.

Myth #3: High-risk pools have traditionally been underfunded by states and the federal government, resulting in poor coverage and high costs for those who need insurance the most.

FACT: The AHCA sets aside $100 billion over ten years to help states with high-risk pools and other innovations. It sets aside an additional $15 billion specifically for maternity care, mental health care, and substance abuse treatment. And it sets aside an ADDITIONAL $15 billion for a federal invisible risk-sharing program -- another innovative way to help people access affordable coverage.

Myth #4: Under this amendment, States do not have to cover essential health benefits.

FACT: This amendment ensures essential health benefits are the federal law of the land and maintains other important protections. States have the option to obtain a waiver regarding federal essential health benefits, but the state must publicly attest its purpose for doing so (to reduce the cost of health care coverage, increase the number of people with health care coverage, etc.) and it must specify the benefits it will require instead of the federal standard. NO STATE, under ANY circumstances, may ever obtain a waiver for pre-existing condition protection, prohibition on gender discrimination, for guaranteed issue and renewability, or for the right of dependents to stay on a family plan up to age 26.

Myth #5: 129 Million Americans have pre-existing conditions and could be denied coverage.

FACT: This legislation addresses the 7% of Americans on the individual market, and those in the small group market. Anyone with employer-provided coverage or government coverage (Medicare, Medicaid, Tricare, VA benefits, etc.) would not be affected. Again, this amendment would not allow any state to deny coverage to those with pre-existing conditions, and would require the extensive protections described above for those with riskier health profiles. It is also worth noting that many states required insurers to offer coverage to those with pre-existing conditions before Obamacare was implemented.

Q: Are Members of Congress and their staff bound to the same rules as everyone else?

A: Members of Congress should live by the same rules as everyone else. Period. We passed legislation in the House to make a simple technical correction to ensure that the American Health Care Act (AHCA) and its amendments apply equally to everyone.

READ THE MCSALLY BILL TEXT: H.R. 2192, To amend the Public Health Service Act to eliminate the non-application of certain State waiver provisions to Members of Congress and congressional staff.

Q: Why did you add the Upton-Long Amendment?

A: The AHCA explicitly maintains protections for pre-existing conditions. Guaranteed issue of coverage, guaranteed renewability of coverage, or the prohibition on insurance companies denying coverage due to pre-existing conditions are all maintained. All of these protections remain the law.

The MacArthur amendment to the AHCA does allow states to seek a limited waiver to allow the insurance companies to charge higher premiums for a person with a health condition only if they do not maintain continuous coverage. The MacArthur amendment only applies to the individual insurance market, where roughly 7 percent of the country purchase coverage. This means that the MacArthur amendment does NOT apply to 93 percent of Americans with employer-provided coverage or government coverage (Medicare, Medicaid, Tricare, VA benefits, and others).

In order to obtain a waiver, the MacArthur amendment requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the Federal Invisible Risk Sharing Program.

Importantly, these higher premiums could only be charged for a period of one year to an individual who did not maintain continuous coverage. After an individual has maintained continuous coverage for twelve months they would then return to standard rates. This means that the protections against being charged higher premiums for a health condition are preserved for every individual market plan holder who maintains continuous coverage.

To address the concerns of higher premiums being charged in the limited circumstances detailed above, the Upton-Long amendment provides $8 billion dedicated solely to reducing premiums or other out-of-pocket costs for the limited group of individuals who:

Reside in a State with an approved waiver
Have a pre-existing condition
Are also uninsured because they have not maintained continuous coverage, and
Purchase health care in the individual market

This funding is on top of the $130 billion available to states through the AHCA’s Patient and State Stability Fund, which helps states repair their health markets damaged by Obamacare. States can use the funds to cut out-of-pocket costs, like premiums and deductibles. States may also use these resources to promote access to preventive services, like getting an annual checkup, as well as dental and vision care. States could use these resources to promote participation in private health insurance or to increase the number of options available through the market.

Further, the AHCA provides a refundable tax credit to those without other health care options so they can get – and stay covered – before they face a serious medical event or suddenly fall ill. These combined resources reaffirm the commitment from House Republicans to ensure Americans with pre-existing conditions are protected.

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