Mississippi governor Phil Bryant would waive certain Obamacare mandates specified in the House-passed health care bill if doing so would improve the state’s insurance market, Bryant’s office told THE WEEKLY STANDARD on Wednesday.
The mandates, which many conservatives have identified as cost-drivers, require insurers on the individual market to offer minimum “essential health benefits” in all plans, and restricts their ability to differentiate insurance premiums based on health status and age. Those prohibitions limit the expenses of individuals with pre-existing conditions, but also force insurers to cover some people at a loss. They became a central negotiating chip before the lower chamber approved the American Health Care Act last week.
Bryant called passage of the AHCA “the first step” in a process Republicans have waited to begin since 2010.
“Rising premiums and vanishing choices make Obamacare unsustainable. The House’s action reflects that reality,” he wrote in a statement to TWS.
The relevant mandates, which are listed in the so-called “MacArthur amendment,” named for author Rep. Tom MacArthur of New Jersey, can only be waived conditionally. An application from a state to the Secretary of Health and Human Services must demonstrate one or more of how the waiver would reduce premiums, increase enrollment or the availability of coverage, and “stabilize” a state’s insurance market or premiums for individuals with pre-existing conditions. The secretary has 60 days to deny the waiver, or it is automatically approved.
A spokesman for Bryant said if the governor determined a waiver would meet such criteria, the state would apply for one. “[I]f Gov. Bryant determined waiving some provisions would decrease costs and expand availability, he would do that.”
Such action, of course, is contingent on the AHCA becoming law, or at least these provisions of it—a doubtful outcome with the Senate making its own designs for a health bill.
Bryant is now the third state executive to comment on the waiver option favorably. South Dakota governor Dennis Daugaard said he would consider affordability issues in contemplating a waiver. “I think most citizens are probably not conscious of the cost, so a responsible government has to weigh both sides. We want to give as much benefit, particularly in health, as you can afford, but you have to be able to afford it,” he said on Monday. Wisconsin governor Scott Walker hedged last Friday when he predicted a waiver is “something we certainly would consider,” a comment he contextualized in a follow-up interview with the Milwaukee Journal Sentinel later in the day. “I’m waiting to see what gets to the president’s desk, but we’re not looking to change pre-existing conditions,” he said.
The under-reported point of opting out of that particular mandate is to help suppress costs in other ways. As written in a summary of the MacArthur amendment, a state cannot waive the health status regulation “unless the state has established a high risk pool or is participating in a federal high risk pool”—the central sources of money to subsidize people with pre-existing conditions. The GOP bill contains $100 billion over nine years that could be used for such a purpose, as well as $8 billion over five years for which risk pool funding is the dedicated purpose. Opponents of the legislation have said $8 billion is paltry.
