New GOP healthcare plan includes federally funded high-risk pools, opt-out for essential benefits
Amendment is modeled after systems working in Wyoming, Utah, Maine and his own state of Wisconsin, Ryan says.
The new amendment to the healthcare bill would offer people with pre-existing conditions greater protections than they now have by guaranteeing funding for catastrophic healthcare costs, House Speaker Paul Ryan said on Thursday
"This has federal funding to it," Ryan said Thursday, without specifying the cost. "This will add federal funding to high risk pools."
The Department of Health and Human Services will coordinate with states, he said.
The amendment is modeled after systems working in Wyoming, Utah, Maine and his own state of Wisconsin, Ryan said.
[Also: GOP adds AHCA amendment to allow states to opt out of essential benefits, pre-existing conditions]
"Now adding federal funding, it will work even better," he said.
The Republican plan to repeal and replace the Affordable Care Act, will be able to offer consumers lower premiums because the federal government would subsidize states to maintain high risk pools, according to Ryan.
"(It will) have federal and state support for people who are sick, support that catastrophic illness with greater subsidies, so that everybody else doesn't have to bear those costs in their insurance pools," Ryan said. "One percent of the people in the individual market drive 23 percent of the cost. So if we directly support that catastrophic coverage - it's sort of reinsurance of top of insurance, then you're lowering everybody else's prices."
Republican moderate Tom MacArthur of New Jersey, a former health insurance executive, put forward the amendment to Ryan's American Health Care Act. The bill will go to a vote when it's ready, Ryan said.
In late March, Ryan was forced to pull the AHCA before the vote when it became clear there was not enough support from conservative members of his party to pass the bill.
The new amendment is aimed at satisfying Freedom Caucus conservatives by giving states the ability to remove the provision for essential health benefits that are currently in the ACA, but were removed in Ryan's American Health Care Act.
Essential health benefits are back in the plan, Ryan said, and states would have to get a waiver to take them out.
"It gives states greater flexibility to bring down premiums," Ryan said.
Moderates within the GOP get to keep the ACA's provision of not denying coverage to consumers who have pre-existing conditions.
"(It) puts more federal protections in on pre-existing conditions," Ryan said. "Even if a state gets a waiver, there are multiple layers of pre-existing condition protections, like continuous coverage. If you have a healthcare problem, and you have health insurance, you cannot be rated for higher healthcare costs. And if you switch to another plan and keep your coverage the same protections apply, even if your state gets a waiver."
Ryan on Thursday would not address a big concern for insurers, that of cost-sharing reduction payments. CSRs are not in the GOP healthcare or spending bill. They have been funded by the administration and not by budget, Ryan said.
Their continued funding is uncertain.
The issue of CSRs is in litigation, Ryan said, referring to House v. Price, formally House v. Burwell. Republican leaders had sued HHS over the ACA payments, saying Congress never appropriated the funds. They won, and President Obama appealed. The case is on hold with a status conference scheduled for May 22.
The federal government pays insurers CSRs, which allow those health insurance companies operating on the exchanges the ability to offer low-income consumers lower deductibles.
Insurers have said they need the stability of the continuation of CSRs to remain in the marketplace without a large hike in premium rates.
Twitter: @SusanJMorse
