GOP Move to Ease Existing-Condition Health Coverage Mandate Could Endure

By Kristina Peterson Features Dow Jones Newswires

One of the most controversial provisions of the House Republican health-care bill had been expected to quietly disappear in the Senate. Now, some government budget experts think it might not.

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The provision would enable states to obtain waivers to opt out of certain Affordable Care Act regulations, which would let insurers offer skimpier but cheaper health plans. The waivers also would allow insurers to charge more to people with existing health conditions who had let their coverage lapse.

States with waivers would have to take steps to offset costs for these people, including potentially setting up high-risk insurance pools.

These provisions, contained in an amendment by Rep. Tom MacArthur (R., N.J.), became one of the biggest flashpoints in the bill the House passed last week to roll back and replace much of the ACA. It sparked a national debate over how to handle people with existing conditions.

Even as the Capitol dealt with the fallout from President Donald Trump's decision to fire FBI Director James Comey, Senate Republicans met daily this week behind closed doors to discuss their own version of the health-insurance bill.

Debate over the MacArthur amendment had been expected to dissipate when the bill arrived in the Senate, whose procedural rules were thought to block it. Republicans hope to pass the bill under a process tied to the federal budget, known as "reconciliation," that allows measures to be approved with a simple majority. Most bills require 60 votes to clear the Senate, where Republicans hold only 52 seats.

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But to take advantage of the reconciliation process, legislation has to comply with the Byrd Rule, which tries to rein in senators from slipping in measures with little effect on the budget. It typically is up to the Senate parliamentarian, currently Elizabeth MacDonough, to recommend whether provisions have enough budgetary impact to qualify.

One important data point will arrive when the nonpartisan Congressional Budget Office releases its estimate of the bill's cost and effect on insurance coverage. The CBO said this week it expected to unveil an updated projection of the final House bill the week of May 22.

Some budget experts said this week it is possible the MacArthur amendment would have enough effect on the budget to comply with the Senate's procedural rules.

"If those [state] waivers have a federal budgetary consequence -- [if] by making those changes it will affect the amount of subsidies or federal expenditures -- I think it would qualify as being legitimate and not violate the Byrd rule," said Bill Hoagland, a senior vice president at the Bipartisan Policy Center who formerly was a veteran Senate staffer specializing in the budget.

For example, states' decision to opt out from some ACA regulations could affect the number of people who can afford insurance, what kinds of federal subsidies they would qualify for, the size of high-risk pools receiving federal funding and the number of people who qualify for Medicaid, Mr. Hoagland said.

Conservatives in the House and Senate have long argued that GOP leaders haven't pushed forcefully enough to include health-care provisions whose compliance with the Byrd Rule could be challenged.

"I would not be believing all of the unsubstantiated rumors of what is and isn't permissible under Senate procedural rules," Sen. Ted Cruz (R., Texas) said this week when asked if the MacArthur provision would likely be stripped from the Senate bill.

When the parliamentarian considers a bill, both Democrats and Republicans get to make arguments in confidential meetings on whether provisions should be allowed. Those who don't think a provision complies with the Byrd Rule can argue that its primary impact is on policy and any effect on the budget is "incidental," a line of reasoning likely to come up with the MacArthur measure.

Some conservatives, including Mr. Cruz, have suggested that if they disagree with the parliamentarian's recommendation, Republicans could enlist Vice President Mike Pence to overrule it in the Senate.

But most Senate Republicans aren't comfortable with overruling the parliamentarian, a move that many think could ultimately end up destroying the 60-vote threshold for most legislation in the Senate, arguably its biggest difference from the House.

"Senate Republicans by and large want to work within the parameters of what the reconciliation process allows and try to get to an outcome based on that," said Sen. John Thune of South Dakota, a member of Senate GOP leadership.

Mr. Hoagland said overruling the parliamentarian "would destroy the budget process." He added, "The budget process is always hanging by a thread anyway."

Write to Kristina Peterson at kristina.peterson@wsj.com

WASHINGTON -- One of the most controversial provisions of the House Republican health-care bill had been expected to quietly disappear in the Senate. Now, some government budget experts think it might not.

The provision would enable states to obtain waivers to opt out of certain Affordable Care Act regulations, which would let insurers offer skimpier but cheaper health plans. The waivers also would allow insurers to charge more to people with existing health conditions who had let their coverage lapse.

States with waivers would have to take steps to offset costs for these people, including potentially setting up high-risk insurance pools.

These provisions, contained in an amendment by Rep. Tom MacArthur (R., N.J.), became one of the biggest flashpoints in the bill the House passed last week to roll back and replace much of the ACA. It sparked a national debate over how to handle people with existing conditions.

Even as the Capitol dealt with the fallout from President Donald Trump's decision to fire FBI Director James Comey, Senate Republicans met almost daily this week behind closed doors to discuss their own version of the health-insurance bill.

Debate over the MacArthur amendment had been expected to dissipate when the bill arrived in the Senate, whose procedural rules were thought to block it. Republicans hope to pass the bill under a process tied to the federal budget, known as "reconciliation," that allows measures to be approved with a simple majority. Most bills require 60 votes to clear the Senate, where Republicans hold only 52 seats.

But to take advantage of the reconciliation process, legislation has to comply with the Byrd Rule, which tries to rein in senators from slipping in measures with little effect on the budget. It typically is up to the Senate parliamentarian, currently Elizabeth MacDonough, to recommend whether provisions have enough budgetary impact to qualify.

One important data point will arrive when the nonpartisan Congressional Budget Office releases its estimate of the bill's cost and effect on insurance coverage. The CBO said this week it expected to unveil an updated projection of the final House bill the week of May 22.

Some budget experts said this week it is possible the MacArthur amendment would have enough effect on the budget to comply with the Senate's procedural rules.

"If those [state] waivers have a federal budgetary consequence -- [if] by making those changes it will affect the amount of subsidies or federal expenditures -- I think it would qualify as being legitimate and not violate the Byrd rule," said Bill Hoagland, a senior vice president at the Bipartisan Policy Center who formerly was a veteran GOP Senate staffer specializing in the budget.

For example, states' decision to opt out from some ACA regulations could affect the number of people who can afford insurance, what kinds of federal subsidies they would qualify for, the size of high-risk pools receiving federal funding and the number of people who qualify for Medicaid, Mr. Hoagland said.

Conservatives in the House and Senate have long argued that GOP leaders haven't pushed forcefully enough to include health-care provisions whose compliance with the Byrd Rule could be challenged.

"I would not be believing all of the unsubstantiated rumors of what is and isn't permissible under Senate procedural rules," Sen. Ted Cruz (R., Texas) said this week when asked if the MacArthur provision would likely be stripped from the Senate bill.

When the parliamentarian considers a bill, both Democrats and Republicans get to make arguments in confidential meetings on whether provisions should be allowed. Those who don't think a provision complies with the Byrd Rule can argue that its primary impact is on policy and any effect on the budget is "incidental," a line of reasoning likely to come up with the MacArthur measure.

Some conservatives, including Mr. Cruz, have suggested that if they disagree with the parliamentarian's recommendation, Republicans could enlist Vice President Mike Pence to overrule it in the Senate.

But most Senate Republicans aren't comfortable with overruling the parliamentarian, a move that many think could ultimately end up destroying the 60-vote threshold for most legislation in the Senate, arguably its biggest difference from the House.

"Senate Republicans by and large want to work within the parameters of what the reconciliation process allows and try to get to an outcome based on that," said Sen. John Thune of South Dakota, a member of Senate GOP leadership.

Mr. Hoagland said overruling the parliamentarian "would destroy the budget process." He added, "The budget process is always hanging by a thread anyway."

Write to Kristina Peterson at kristina.peterson@wsj.com

(END) Dow Jones Newswires

May 12, 2017 18:35 ET (22:35 GMT)