Town hall meetings got loud for some Republican members of Congress this week, as they defended the passage of the American Health Care Act by the House of Representatives. Constituents have been asking a lot of questions, and we've been fact-checking the answers given by some leading GOP lawmakers.
Tom Reed, R-N.Y., at a town hall meeting in his district
"The pre-existing reform is not repealed by this legislation."
Fact check: That's not the whole truth
Reed was responding to a constituent who was concerned about a child with severe allergies: "His co-pays and deductibles will be through the roof," the parent told Reed, "because he's going to be in a high-risk pool — because he has a pre-existing condition."
"No, no, no," Reed told the parent.
The bill does have language that says insurers cannot deny people coverage or charge them more just because they have a pre-existing condition.
However, the GOP bill also has an enormous loophole in that regard. The plan allows states to apply for waivers from the federal government that get them out of many of the regulations put in place under the Affordable Care Act — including one that bans insurance companies from charging people with pre-existing conditions more for a health plan. A waiver would allow insurance companies to consider a person's health status when determining what to charge for coverage. And that means that although someone with a pre-existing condition who lives in a state that got a waiver would have to be offered a policy, it could be very expensive.
Steve Scalise, R-La., on Fox News this week
"No matter what kind of plan you have today," Scalise told Fox News, "if you have a pre-existing condition, under our bill, you cannot be denied coverage and you cannot be charged more than anybody else."
Fact check: Not exactly true
Scalise, like Reed, is pointing to the language in the bill that retains the Obamacare rules that prohibit insurers from charging people with expensive medical conditions more than their neighbors of the same age for an insurance policy.
But the state waivers allow insurers a way around that guarantee.
Before the Affordable Care Act, insurance companies denied coverage or charged more if the person who wanted insurance had any of a long list of conditions — including arthritis, diabetes, heart disease, muscular dystrophy, obesity and sleep apnea, according to a list compiled by the Kaiser Family Foundation from insurers' underwriting guidelines.
Insurers also could refuse to cover many medications, including drugs that treat cancer, diabetes, AIDS or arthritis, according to Kaiser.
If you have cancer and buy insurance that doesn't pay for your cancer treatment, your pre-existing condition is effectively excluded.
Rod Blum, R-Iowa, at a town hall in Dubuque
"If you're getting your insurance through the group health care marketplace — your employer — nothing changes," Blum told constituents this week. "If you're getting your health insurance through Medicare, nothing's going to change. If you're currently getting your health insurance through Medicaid, nothing's going to change."
Fact check: Partly false
Blum's statement refers to a couple of big things — employer coverage and Medicaid.
As to employer coverage, whether your insurance would change under the GOP bill depends on whether your company is based — and buys its insurance — in a state that gets a waiver.
In "waiver states," employers' insurance policies might no longer be subject to Obamacare regulations around so-called essential health benefits — the minimal benefits that must be included in a policy.
They also might no longer be subject to restrictions on annual and lifetime spending caps.
That means, in those states, your employer-sponsored health insurance policy could deny coverage for some categories of care, such as mental health care or maternity coverage. And the health plan could impose annual or lifetime limits on insurance benefits. So workers with very expensive conditions, or their family members with such conditions, could see their costs pile up — even if they have health coverage through work.
Before Obamacare, about 60 percent of employers had lifetime limits on their health plans.
Blum's second statement — the one in regard to Medicaid — is false. The GOP health bill makes major changes to Medicaid, first by rolling back the expansion of the program over time.
The bill allows people to keep their expanded Medicaid as long as they remain eligible. But people at or near the poverty level often see their incomes fluctuate, making them temporarily ineligible for the health care program. Under the GOP bill, once they leave the Medicaid rolls, they likely would not be able to return, even if their income declines. That's because the federal government would pay a lower share of their costs and most analysts --including those at the Congressional Budget Office -- believe that most states are unlikely to continue the expanded coverage at the higher cost.
In addition, the bill fundamentally changes how the U.S. government finances Medicaid. States would receive a fixed amount of money from the federal government for each beneficiary, rather than an amount that varies according to the numbers of Medicaid beneficiaries and their health care needs.
Most analysts say that, over time, the level of services Medicaid could provide would decline if the GOP health bill becomes law, and the states would have to cut back on services. That forecast is borne out by the Congressional Budget Office, which said the changes to Medicaid would cut the costs of the program by $880 billion over 10 years.
Many services provided by Medicaid today, including home health care and services for people with disabilities, are considered "optional" under the GOP health bill. Those are also the services that help keep people out of hospitals and nursing homes.
KELLY MCEVERS, HOST:
Many House Republicans are back in their districts this week after voting for a replacement for the Affordable Care Act, or Obamacare. A few are holding town hall meetings. And in some cases, those town halls are loud.
(SOUNDBITE OF ARCHIVED RECORDING)
TOM REED: I'll tell you...
UNIDENTIFIED WOMAN #1: If you get health care (unintelligible).
REED: ...I will tell you where I stand on the issues.
UNIDENTIFIED WOMAN #2: Do you think health care is a right?
REED: I do not support...
MCEVERS: Other House Republicans are making their case on television that the plan they voted for is better than the status quo. NPR Health Policy Correspondent Alison Kodjak is with us now to fact-check some of the things that they are saying. Hi there, Alison.
ALISON KODJAK, BYLINE: Hi, Kelly.
MCEVERS: So we just heard Congressman Tom Reed's town hall in Ashville, N.Y. Sounds like the audience was pretty riled up.
KODJAK: Yeah, they sure were. Reed held a series of town halls, which pretty brave. And there were definitely some voters who liked the bill because they thought it might cut their premium costs. But over and over again, people were asking how it would deal with people who have expensive medical conditions. Here's one exchange from a town hall in Busti, where a constituent was worried about a child with severe allergies.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN #3: Copays and deductibles that are going to be through the roof because he's going to be in a risk pool because he has a pre-existing condition.
REED: No, because we're not - the pre-existing condition reform is not repealed by this legislation.
MCEVERS: Alison, is that true or false?
KODJAK: Well, it's not exactly true. That language is in the bill. So on its face, there is this protection. But there's also a huge loophole. The bill allows states to get waivers to get out of a lot of the regulations under the Affordable Care Act. One of those waivers allows insurance companies to do what's called medical underwriting. That means that they can charge people more if they have pre-existing conditions. And they can also exclude coverage for certain conditions and medications.
MCEVERS: The question of pre-existing conditions seems to be an ongoing theme among House Republicans. Steve Scalise, the Louisiana congressman, said this on Fox News over the weekend.
(SOUNDBITE OF ARCHIVED RECORDING)
STEVE SCALISE: No matter what kind of plan you have today, if you have a pre-existing condition, under our bill, you cannot be denied coverage and you cannot be charged more than anybody else.
KODJAK: Yes. And he's right that people can't be completely denied coverage. But they can, in fact, be charged more, just as I said before. And again, that's going to depend on where you live, whether you're in a state that gets a waiver. And I have in front of me a whole list of medications and conditions that insurance companies used to use to exclude people or to charge them more. And those medications, especially, include anti-arthritis medications, anti-cancer medications, drugs for AIDS. So there's a lot of ways that they could not give people the coverage they need.
MCEVERS: There also seems to be confusion about exactly who this new law would affect. Congressman Rod Blum in Iowa was telling his constituents the impact won't be all that widespread. Let's listen.
(SOUNDBITE OF ARCHIVED RECORDING)
ROD BLUM: If you're getting your insurance through the group health care marketplace, your employer, nothing changes.
BLUM: If you're getting your health insurance through Medicare, nothing is going to change.
BLUM: If you're currently getting your health insurance through Medicaid, nothing's going to change. You're still going to get your insurance.
MCEVERS: OK, so is that right, nothing's going to change?
KODJAK: Well, not exactly. If you work for an employer that's in a waiver state, that employer's not going to be subject to the Obamacare regulations either, so your insurance could end up having annual spending limits, lifetime caps. Before Obamacare, 60 percent of employer policies had lifetime caps. And if you're on Medicaid, a lot could change. The Medicaid expansion states will rollback benefits. So people who have benefits that aren't required under the program - and that's a lot of the benefits for people who have home health care and care for people with disabilities - those are going to probably be rolled back over time, too.
MCEVERS: That's NPR Health Policy Correspondent Alison Kodjak. Thanks a lot for the fact check.
KODJAK: Thank you, Kelly.
(SOUNDBITE OF VINCE GUARALDI TRIO'S "CHARLIE BROWN THEME") Transcript provided by NPR, Copyright NPR.