President Trump appeared to suggest on Sunday that the GOP's new iteration of its healthcare bill to repeal and replace the Affordable Care Act would cover pre-existing conditions for all Americans.
Trump, seeming to break from House Republicans' latest proposal that states could opt out of an Affordable Care Act requirement on covering pre-existing conditions, told CBS' John Dickerson on "Face the Nation" that congressional leaders were making changes to the newest bill to provide for nationwide pre-existing conditions coverage.
"Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be,'" Trump said.
Trump's first replacement bill included that provision, but it was pulled from the floor of the House before it could come to a vote after it became clear the bill did not have enough support to pass, largely because the ultraconservative House Freedom Caucus said it did not go far enough to repeal Obamacare in its entirety.
In order to bring members of the Freedom Caucus on board, leader of the Tuesday Group, NJ Rep. Tom MacArthur, introduced an amendment on Tuesday that would allow states to opt out of the two largest Obamacare provisions.
In addition to allowing states to waive coverage for essential health benefits — like maternity care and emergency-room visits — the amendment also allows states to waive parts of the community rating. Community-rating rules under the Affordable Care Act prohibit insurance companies from charging higher premiums to those with pre-existing conditions.
Under MacArthur's proposal, states would have the option of waiving that requirement, meaning insurance companies could ostensibly charge higher premiums to sicker people. States would be eligible to apply for a waiver if they provide some funding for people with preexisting conditions to get coverage, participate in the "invisible high risk pools" established by the AHCA, or "provide incentives to appropriate entities" to "stabilize premiums."
But in Sunday's interview, Trump seemed to suggest that the amendment will be altered to ensure pre-existing conditions coverage for people regardless of where they live.
"In one of the fixes that was discussed, pre-existing [coverage] was optional for the states," Dickerson said.
"Sure, in one of the fixes," Trump replied. "And they're changing it."
"So it'll be permanent?" Dickerson asked.
"Of course," Trump said.
(CBS/Face The Nation)
When Dickerson sought to get a clearer answer from Trump, however, the president seemed to hedge. "So what I hear you saying is pre-existing is going to be in there for everybody, it's not going to be up to the states?" Dickerson asked.
"Pre-existing is going to be in there and we're also going to create pools," Trump said, referring to the high-risk pools Republicans have proposed in order to cover the cost of healthcare for those who are sicker. "And pools are going to take care of the pre-existing."
Vice President Mike Pence also echoed Trump's point on high-risk pools when he was asked to address the issue of rising premiums for sicker people on Sunday's "Meet the Press" with Chuck Todd.
"We're basically borrowing an idea from the state of Maine that has seen a significant drop in premiums for people on their health insurance, because you take people that have pre-existing and costly conditions and put them into a high risk pool," Pence told Todd. "And you subsidize that so that it is affordable to those individuals."
Although Republicans have championed the idea of state high-risk pools, critics say that an inevitable effect of isolating the sickest people into separate groups is skyrocketing premiums.
The effectiveness of state high-risk pools has been contested, because the program's success depends on whether the federal government decides to adequately subsidize them — likely through raising taxes. Some notable high-risk pools have also failed in the past.
Dickerson continued to press Trump, asking, "But on that crucial question, it's not going to be left up to the states? Everybody gets pre-existing, no matter where they live?"
Trump then spent some time talking about how he ultimately wanted healthcare to be managed by the states, saying he'd "rather have the federal government focused on North Korea."
When Dickerson repeatedly asked Trump whether he could guarantee that the new Republican healthcare proposal would not lead to unaffordable costs for those with pre-existing conditions, Trump said, "Well, forget about unaffordable. What's unaffordable is Obamacare, John."
"So I'm not hearing you, Mr. President, say there's a guarantee of pre-existing conditions," Dickerson said.
"We actually have — we actually have a clause that guarantees. We have a specific clause that guarantees," Trump said.
If the president and congressional Republicans are working on making changes to the healthcare bill to ensure pre-existing conditions coverage, it will likely pick up more support among moderate Republicans who have expressed concerns about the legislation as it currently stands.
"It could affect people with preexisting conditions and it’ll make different insurance probably much more expensive for them, and in some cases perhaps inaccessible," said Pennsylvania Rep. Charlie Dent.
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