Weeks after House Republicans advanced the American Health Care Act (AHCA), the Congressional Budget Office (CBO) finally issued its scoring of the bill and found exactly what most experts had already projected: higher costs and less coverage, particularly for those who need health care the most, like those with pre-existing conditions.
But this information apparently shocked and upset House Freedom Caucus Chair Mark Meadows (R-NC), who pushed for the bill’s passage.
According to the Independent Journal Review, when Meadows first greeted reporters after the CBO report came out, he was optimistic about its findings. But then, reporters started asking him more about the report’s actual findings — specifically that, thanks to the state waivers he championed, people with pre-existing conditions could be charged higher premiums and even priced out of the insurance market altogether.
Meadows was caught off guard, responding, “Well, that’s not what I read” and putting on his reading glasses to reexamine the relevant paragraph. He suggested to reporters that he’d be willing revisit the question of how much funding to allocate for high-risk pools.
Suddenly, as the Independent Journal Review reports, he was choking back tears:
Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.
In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.
If the high-risk pools are not properly funded, patients with pre-existing conditions could expect waiting lists, sky-high deductibles, and premiums double the standard rates.
Under Meadows’s leadership, the House Freedom Caucus officially endorsed the AHCA after “improvements” made by an amendment from Rep. Tom MacArthur (R-NJ). The AHCA allocates $15 billion over nine years to support high-risk pools for people with pre-existing health conditions, and MacArthur’s amendment provided an additional $8 billion over five years to subsidize costs for those with pre-existing conditions.
In the lead-up to the House’s vote, there was plenty of evidence that this funding was nowhere near sufficient to actually cover these people.
According to a study from Avalere that came out the day of the vote, the current funding levels under the AHCA will cover only about 110,000 individuals with a pre-existing chronic condition. If states use other available funding streams in this way, they could cover up to 600,000 individuals with pre-existing chronic conditions. That’s still not even half of the 2.2 million enrollees who have a preexisting chronic condition, and it doesn’t account for the many other patients who have pre-existing conditions affecting their coverage that might not be chronic.
A report from the Center for American Progress that came out two days before the vote noted that about half of the 31 million people insured through small-group and individual markets have at least one pre-existing health condition. In order for the AHCA subsidies of high-risk pools to cover at least as much as the Affordable Care Act already does, the government would have to spend $32.7 billion per year — and even then, high-cost consumers would still owe $10,000 toward premiums annually.
It’s unclear if, like several other lawmakers who voted for the AHCA, Meadows simply didn’t read the bill, or if he just refused to believe what most independent analysts concluded.
But if House Speaker Paul Ryan (R-WI) hadn’t rushed a vote on the legislation before waiting for the CBO score, Meadows could have wept for those most in need before he gave the AHCA his stamp of approval.
CLARIFICATION: This piece has been updated to clarify the point at which Meadows became choked up in his conversation with reporters.