The Republican-controlled 115th Congress was poised to honor a long-standing campaign promised in July 2017.
Using the Senate’s budget reconciliation rules to set up a party-line vote on the American Health Care Act, it was closing in on a partial repeal of the Affordable Care Act. But Arizona Republican John McCain threw the plan, signaling a thumbs-down that defeated the bill 51-49.
Democrats took control of the House in the 116th Congress, ending the opposition’s bid to undo legislation the Democrat-controlled 111th Congress passed in 2010 without a single Republican vote.
“I realized we weren’t going to be able to change health care through reconciliation to make meaningful changes,” Rep. Bruce Westerman, R-District 4, said of the Senate’s failure to pass the American Health Care Act. “We have to do something that’s bipartisan that can get 60 votes in the Senate.”
The Congressional Budget Office said the so-called “skinny” repeal bill would have decreased the budget deficit but increased the number of uninsured people.
“Some people would say if it keeps increasing costs the Republicans won’t support it,” Westerman, who’s represented southern and western Arkansas in the US House since 2015, said. “If it doesn’t cover more people, Democrats won’t support it. If it doesn’t cover preexisting conditions nobody will support it.”
Westerman said the Fair Care Act bill he’s co-sponsoring with Rep. Anthony Gonzalez, an Ohio Republican, addresses the priorities of lawmakers across the political spectrum. His office said it includes 75 bipartisan provisions.
“Instead of saying, ‘Let’s wipe out the Affordable Care Act,’ let’s take some things that are good in it, and let’s take other good health care policy, regardless if it’s Republican idea or a Democrat idea, and put it all together in one bill,” Westerman said. “The language comes back to lowering costs, covering more people and covering preexisting conditions.”
Earlier versions never got out of committee and weren’t debated. Westerman said he and Gonzales’ bill may never advance to the House floor, but elements of it could become stand-alone legislation that eventually reaches the president’s desk.
“I’ve talked to people who may run for president, may get elected president one day, who know this bill’s out there,” Westerman said. “Somebody who gets elected president may know about this bill and put it in their platform for health care.
“It’s good to have bills drafted. You’ve got something that people can go to. We’ve done a lot of research and have a lot of data to justify the language that was done in the bill. I feel good about having done my job of putting good health care policy forward. Who knows what fate it will have when you’re dealing with Congress.”
The Affordable Care Act’s market-based exchanges for buying health insurance proceeded from a Republican idea, Westerman said, explaining that the Fair Care Act would grow the marketplace and extend insurance coverage to more people.
“One way to do that is to put federal employees into the exchanges,” he said. “Instead of doing Medicaid for low income you put them into the exchanges and change the ratios of how the premium assistance goes to people who are low income, and you create reinsurance pools to cover people with the most serious health concerns.”
The Affordable Care Act uses tax credits applied to monthly premiums of insurance coverage purchased on the exchanges. The subsidy generally phases out when an enrollee’s income reaches 400% of the federal poverty level, creating what’s been called the “subsidy cliff.”
The Inflation Reduction Act, the reconciliation bill being debated in the Senate, extends through 2025 the American Rescue Plan Act provision that did away with the cliff in 2021 and 2022. The premium share for enrollees with incomes greater than 400% of the poverty level is capped at 8.5% of their annual income.
Westerman said his bill would expand the subsidy to people with incomes up to 600% of the poverty level and flatten the cliffs.
“When you graph it, it’s a much smoother curve without cliffs and transitions,” he said. “The way the premiums are structured under the Affordable Care Act, you create these cliffs. It’s not fair to younger people or older people the way the premium assistance is crafted right now.”
Westerman said his bill would allow workers to take money from their paychecks before taxes are withheld and use the pretax dollars to buy health insurance.
“You would allow private employers, instead of providing a company health care plan, they could pay their employees’ pretax dollars, and the employees could go out and buy their own plan on the marketplace,” he said. “Health care wouldn’t be tied to employment. You’d make the transition from one job to the other more seamless and less tied to the employer.”
The Inflation Reduction Act’s prescription drug provisions would save Medicare almost $300 billion over the next 10 years, according to the Congressional Budget Office. Allowing Medicare to negotiate prices on some of the costliest drugs is one of the cost-saving measures.
“I think that’s a bad idea,” Westerman said. “What they’re going to do is end up capping prices. What they’re going to do is quell innovation in the pharmaceutical market. I think there’s better ways to do it. If Medicare says this is the price for a drug, that will have a ripple effect throughout all of health care. When you’re negotiating with the US government, you’re not really in a negotiating position.”
Westerman’s bill targets pharmacy benefit manager practices. Prescription drug insurance plans use PBMs to process and pay claims, contract with pharmacies and negotiate discounts and rebates with drug companies. The Fair Care Act would eliminate PBM fees that can make it difficult for pharmacies to cover their costs. Paying to participate in an insurance plan’s network is one of the most common fees.
The Arkansas Legislature passed a law in 2015 that allows pharmacies to refuse to fill prescriptions if reimbursements paid by PBMs don’t cover the pharmacy’s cost.
“They are like leeches sucking cash off the pharmaceutical companies, the pharmacies and the patients, and they’re all government mandated,” Westerman said of PBMs. “We really do a number on the pharmaceutical benefit managers in the Fair Care Act. That’s the kind of bad government we need to get out of health care.”