House Democrats began making good on their campaign promise to shore up the Affordable Care Act on Thursday, passing a bill that would bar the Trump administration from granting states some waivers to the landmark health-care law.
The votes come as President Trump recently renewed his vow to repeal the 2010 law and directed the Justice Department to support a lawsuit aimed at invalidating the law entirely — including its popular protections for Americans with preexisting medical conditions.
Trump has vowed to run on health care and has said his campaign would present a plan to voters. Republicans, however, have failed to come up with an alternative to the law and there is no GOP effort in Congress to craft a replacement.
None of the House bills approach anything near the kind of massive expansion of government-run health care that a number of liberal Democrats are now advocating, including several of the 2020 presidential candidates. Instead, under Speaker Nancy Pelosi (D-Calif.), House leaders are pursuing a measured strategy aimed at highlighting Democrats’ efforts to protect coverage for people with preexisting conditions without wading into the murky political waters of a Medicare-for-all type of plan.
“We invite it to be very bipartisan — send it to the Senate, and hope that the president of the United States, who says he supports [benefits for people with] preexisting conditions, signs it into law as soon as possible,” Pelosi said.
That appears to be a pipe dream. Though there was a faint glimmer of potential cooperation Thursday on a White House proposal to end certain surprise hospital bills not covered by insurance plans, the Democratic health-care bills have sparse Republican support, and none are expected to be considered by the GOP-controlled Senate.
The Trump administration and GOP lawmakers have defended the expanded ACA waivers as a way to allow states to lower insurance prices. But Democrats say the practical effect will be to allow the sale of less comprehensive plans that could leave Americans vulnerable to coverage gaps.
The House passed the bill blocking the waivers, 230 to 183, with four Republicans joining all Democrats.
House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) said during debate Thursday that the short-term plans allowed under the administration waivers would undermine the viability of the more comprehensive plans that many Americans with preexisting conditions rely on.
“The administration is giving insurers the green light to directly discriminate against people with preexisting conditions,” Pallone said. “It’s giving the green light for these plans to charge people with preexisting conditions more money. And it’s giving these plans the green light to refuse to cover any treatment that is related to someone’s preexisting condition.”
Republicans disputed that characterization Thursday, saying that despite the bill’s name — the Protecting Americans with Preexisting Conditions Act — the waivers it targets would not erode those protections. They argued that the administration could not waive the ACA’s provisions mandating that insurers sell policies to those with preexisting conditions.
“The misleading title of this bill confirms the Democratic majority position is to score political points instead of governing,” said Rep. Greg Walden (R-Ore.). “They claim their agenda is for the people. Well, this bill is for the politics.”
Democrats retorted that, under the Trump waivers, Americans with preexisting conditions could be forced into an untenable choice: “Either stay in your ACA plan and see your premiums rise as healthy people move to cheaper junk insurance,” said Rep. Tom Malinowski (D-N.J.), “or sign up for a junk plan yourself and risk getting gouged when the services you need aren’t covered. You end up with a two-tier health-care system in America — one for healthy people and one for sick people.”
The package of bills set for a vote next week includes some bipartisan bills aimed at streamlining the introduction of generic drugs in a bid to lower pharmaceutical costs. But it also includes more bills that seek to directly overturn administration health-care moves.
One would reverse cuts to outreach and enrollment funding that was included as part of the ACA to help Americans as they sign up for health care through marketplaces or other government programs. Another would shore up the ACA’s navigator program, which provides grants to independent outside groups to help Americans enroll in insurance plans. A third would undo other administrative moves to allow for more of the loosely regulated short-term plans that many Democrats deride as “junk” insurance.
The most glaring threat to the ACA, however, is the pending lawsuit filed by Texas and 17 other GOP-led states. While the federal government is the defendant in that suit, the Justice Department earlier this year joined the plaintiffs instead in arguing that the ACA is wholly unconstitutional and should be invalidated. Sixteen states and the District of Columbia have filed to defend the lawsuit.
The U.S. Court of Appeals for the Fifth Circuit on Thursday tentatively set oral arguments in the case for July 8, keeping it on track to remain a live issue throughout the 2020 presidential and congressional campaigns.
House Democrats voted last month on a resolution condemning the administration’s support for the lawsuit. In January, the House voted to authorize its lawyer to intervene in the lawsuit in support of the ACA.
Meanwhile, on the presidential campaign trail, Democratic candidates have largely moved to the left. While some have embraced the Medicare-for-all paradigm, including the possible end of private insurance, even centrist candidates have called for a “public option” that would be offered alongside private insurance plans — expanding the ACA well beyond its initial bounds.