MacArthur Amendment to AHCA Would Mean Higher Premiums for Age and Preexisting Conditions

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We already know that health insurance legislation known as the American Health Care Act (AHCA) is a bad deal for older Americans ages 50-64. For people who purchase coverage on their own in the individual (nongroup) market and are not yet eligible for Medicare, the bill would significantly increase premiums for all older adults and spike costs dramatically for lower- and moderate-income older adults.

Now a bad bill just got worse. The House is considering a new amendment introduced by Rep. Thomas MacArthur (R-N.J.) that would make the legislation even more harmful for older consumers. The MacArthur amendment establishes state waivers that would allow insurance companies to charge older Americans and people with preexisting health conditions higher premiums and weaken critical consumer protections.

Even Higher Premiums for Older Adults

AARP strongly opposes the AHCA for eliminating the 3:1 limit on age rating in current law, which prohibits insurance companies from charging older adults more than three times the premium a younger person pays for the same coverage. The AHCA as originally proposed would allow insurance companies to charge older adults significantly higher rates — up to five times as much as younger adults. The MacArthur amendment goes further by allowing states to set even higher limits — so that older adults could be charged six times, or more, what younger adults are charged.

Because of these changes, lower- and moderate- income older adults, who would receive significantly less tax credit assistance under the bill, would end up paying significantly higher premiums than under current law. Since the MacArthur amendment would allow insurers in waiver states to charge older adults even higher prices for health insurance, their premiums would increase more than what we previously estimated.

Loss of Protections for People with Preexisting Conditions

The amendment would also allow insurance companies to return to charging people with preexisting conditions higher rates based on their health status — something that was previously common practice among insurers but prohibited by the ACA. If a person experiences a break in insurance coverage, insurers in waiver states could be free once again to charge people with preexisting conditions significantly higher, and potentially cost-prohibitive, rates. This would hit the older adult population hard, since 40 percent of 50- to 64- year olds have a preexisting condition.

Reduced Coverage and Fewer Choices for Older Adults and People with Preexisting Conditions

The MacArthur amendment would allow states to waive federal standards for minimum coverage (known as Essential Health Benefits) and instead set their own standards. Under current law, insurance companies have to sell plans that include basic comprehensive coverage, requiring benefits such as prescription drugs, rehabilitative services, and mental health care. Under this amendment, states could set standards that allow insurers to sell less comprehensive, potentially even skimpy coverage.

Once a state chooses to eliminate the requirement that policies include certain benefits, it is unlikely that those benefits would be offered at all in the individual market in that state. The result would be less choice and reduced access to needed services for people with preexisting conditions and health needs.

Weaker Protections Against Lifetime and Annual Limits — Even for Those with Employer-Sponsored Coverage

The MacArthur amendment’s language allowing states to weaken Essential Health Benefit requirements also would weaken another, related set of consumer protections — the ACA’s limits on annual out-of-pocket spending and ban against lifetime and annual insurance limits. For example, as a result of the ACA, 105 million Americans, including people with employer-based coverage, benefit from the law’s ban on lifetime limits, providing consumers with critical protection from the risk of medical bankruptcy. Under the MacArthur amendment, waived essential health benefits would no longer be included in these protections. This would be particularly harmful for people with preexisting conditions or people who develop serious health problems if the services they need once again become subject to such limits.

The MacArthur amendment, simply put, makes a bad bill even worse.

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Jane Sung is a senior strategic policy adviser with AARP’s Public Policy Institute (PPI), where she focuses on health insurance coverage among adults ages 50 and older, private health insurance market reforms, retiree coverage, Medicare supplement insurance and Medicare Advantage.