New Jersey Rep. Tom MacArthur has experienced personal tragedy and understands the need for health insurance.
"I lost my mother at 4 years old. My father had no insurance and I watched him until I was in college pay off medical bills," says the two-term Republican lawmaker.
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Years later, MacArthur suffered the anguish over the death of his 11-year-old daughter, Gracie. "We had over $1 million of medical bills. I had insurance, but I still had a lot of uncovered expenses, and it's brutal," he says.
Yet MacArthur opposes the Affordable Care Act, President Barack Obama's law that has brought health insurance to millions more Americans. The congressman points out that, in many states, the number of insurers offering coverage is dwindling. He says his one and only goal in offering a proposal to resuscitate the Republican effort to repeal Obama's health care law is to help the individual health insurance market survive.
"I'm acting as an individual trying to solve a problem," he says. "That's what I came here to do."
His proposal has won over recalcitrant conservatives and pushed the legislation closer to a vote, a long-sought goal of President Donald Trump and GOP leaders. But it has frustrated many of MacArthur's fellow moderates, who complain that the latest repeal iteration would hurt people with pre-existing conditions and deny basic services like maternity and newborn care. And in his swing district that stretches from the Pennsylvania border to the Jersey shore, and voted twice for Obama, some constituents are not happy.
Protesters gathered outside MacArthur's district office on Friday. The campaign arm for House Democrats boasts that MacArthur's efforts have been a great recruiting tool in its efforts to take the district in next year's midterm elections.
Amid the clamor, the little-known, 56-year-old lawmaker is defending his work. Under his measure, states could get federal waivers to the requirement that insurers charge healthy and sick customers the same premiums and that they cover specified services like preventive care and wellness visits.
MacArthur's work has shifted the dynamics in the health care debate. Before conservatives signed on to his proposal, members of the conservative House Freedom Caucus were catching heat for the bill's failure. Now, the pressure is on the moderate members of the caucus known as the Tuesday Group.
"Now, the Tuesday Group has the hot potato," said Rep. Chris Collins, R-N.Y. "It's not the first time we've had to take the tough votes and here we are again."
Members of the moderate wing aren't publicly critical of MacArthur, who repeatedly has emphasized he was not negotiating for members of the group, only for himself. Some members have expressed concerns that the bill now will allow states to approve waivers that would make it more expensive for people with pre-existing conditions to obtain health insurance.
MacArthur disputes the argument that the bill will hurt vulnerable populations by allowing people with pre-existing conditions to be charged more for insurance.
"It doesn't allow a state to do anything with premiums based on health status unless they've created a fund to help those very people," MacArthur said. "And to help the states start them, we have a $130 billion patient stability fund, which is part of the bill. Fifteen billion is targeted just for mental health care and maternity, but the other $115 billion is all available to help the states create these very kinds of pools and make them successful."
Before the recent events in the health care debate, Democrats had already targeted MacArthur's district as one of their top priorities in the coming election. The Democratic Congressional Campaign Committee recently took out digital ads targeting 30 Republican-held seats on the health care proposal. It spent the most in MacArthur's district.
"The energy on the ground is incredible and its' going to help up flip his district," said Evan Lukaske, a spokesman for the committee.
About 40 protesters converged on MacArthur's district office in Marlton, New Jersey to protest his work on the health care bill. One sign read "Don't Take Our Health Care," and another "MacArthur's Bill Kills."
Laurel Smith, 56, of Medford, New Jersey, says she is concerned because her 26-year-old son, Jamieson Smith, has a rare sickness called mitochondrial disease. The illness can lead to loss of muscle coordination and weakness, and harm key organs. She's concerned repeal of the Affordable Care Act could affect his coverage.
Smith said she particularly worried about states' ability to opt out of coverage requirements. "There's lots of opportunities for states to play around with it," Smith said.
A former Obama administration official, Andrew Kim, said he's exploring an election bid to unseat MacArthur.
Associated Press writer Michael Catalini in Marlton, New Jersey, contributed to this report.
On Twitter, reach Kevin Freking at https://twitter.com/APkfreking