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CRAMER OP-ED: Pre-existing conditions and the American Health Care Act

U.S. Rep. Kevin Cramer, R-ND.

During the three Coffee With Cramer townhalls I held in Minot, Mandan and Bismarck last week, many people came to talk about the legislation passed by the House of Representatives on May 4 to begin the process of repealing and replacing Obamacare. In passing the American Health Care Act (AHCA), we are replacing this failed Obamacare law with a more patient-centered, affordable and flexible system.

Based on the comments shared at these meetings, what is more clear than anything else is how inaccurate messaging and outrageous claims flooding the media about this legislation have caused unnecessary concern and made it difficult for North Dakotans to know who exactly they can trust.

I have read the 200-page bill in its entirety and debated nearly every section of it during a 27-hour hearing in the House Energy and Commerce Committee in March. It delivers nearly $900 billion in tax relief for people in all income brackets, which puts more money in your hands. And, it harnesses the free market to drive down costs and ensure Americans retain access to quality care. Through the shaping of the AHCA, House Republicans and President Trump insisted it contain language preventing lifetime caps on medical care, allowing dependent children to stay on their parents' plans until age 26 and prohibiting any policy from refusing coverage for pre-existing conditions.

It's the pre-existing conditions language that has generated the most outrageous and false claims. The bill is very clear that insurers must cover individuals regardless of health status — and this means any pre-existing conditions. Insurers will not be able to charge higher premiums because of an illness if individuals maintain continuous coverage. And if there is a lapse in coverage that would cause a higher premium, there are several safety nets in place to cover the cost of any increased premium cost. This is the language in the bill.

One of the most blatant scare tactics being spread is the AHCA will take away health insurance coverage to 300,000 North Dakotans who have pre-existing conditions. Let's run the math on this. The AHCA affects only individuals who purchase their health insurance on the individual market - this means it does not apply to anyone whose health care is covered through employer policies, Medicare, Medicaid, the Veterans Administration or Tri-Care. In North Dakota, roughly 8 percent of our population purchases health insurance in the individual market. Of those folks who purchase insurance in the individual market, about 24 percent of people under the age of 65 have a preexisting condition. This equates to about 2 percent of the population. Further, for someone in that 2 percent to be charged higher premiums, North Dakota would have to seek and receive a waiver from the federal government, and the individual would have to have a lapse in coverage of more than 63 days. Only then, in this hypothetical situation, could an insurer ever charge higher premiums for up to one year. But even then, the AHCA sets aside $8 billion specifically for this small percentage of the population to assist them with paying premiums so they would still be covered. Those are the objective facts.

Another outrageous claim is that rape and sexual assault will be considered a pre-existing condition and not covered under the AHCA. Michelle Ye Hee Lee disputed these lies in her Fact Checker Analysis in the May 6 Washington Post. In her analysis she writes, "the notion that AHCA classifies rape or sexual assault as a pre-existing condition, or that survivors would be denied coverage, is false. At least 45 states prohibit insurance discrimination like this. Then it takes several leaps of imagination to assume that survivors of rape and sexual assault will face higher premiums as a result of conditions relating to their abuse." In rating this outrageous claim in her Pinocchio Test, Ms. Lee concludes, "the more complicated the topic, the more susceptible it is to spin. Both media coverage and hyperbole among advocates are at fault for creating a misleading representation of the House GOP health bill. We wavered between three and Four Pinochhios, but the out-of-control rhetoric and the numerous assumptions pushed us to Four Pinochhios."

I have held townhall meetings as long as I have been in Congress and I concluded a long time ago that we will never all agree on every issue. Developing the right federal policy on health care coverage is one of them. One of my campaign promises was to work to repeal Obamacare and replace it by removing the federal government from being between the health care decisions of individuals and their doctors. And as long as I have the privilege of being North Dakota's Member of Congress in the House of Representatives, I will work toward that goal.

Some of the most vocal critics of the AHCA are those who philosophically support the United States having a single-payer health care system. I do not support this because I believe it will bring an end to our nation having the best health care system in the world. Great Britain, for example, has a single-payer system in place, which is plagued by a massive waiting list, and explicit government rationing for services such as hospice care, heart surgery, and kidney dialysis. Without free market health care, companies would quit innovating, which would reduce the quality of our entire system.

Obamacare took away the free market approach, and replaced it with a government mandated program that is unaffordable and unsustainable. For those who claim the Obamacare took away preexisting conditions, tell that to the families with preexisting conditions, including mine, who have "coverage" under Obamacare, but can't afford the $1,000 monthly premium and $10,000 deductible that comes with their plan.

The American Health Care Act will provide better health care for people with pre-existing conditions than Obamacare ever did, and it will do so while also bringing down health insurance costs for the rest of us.

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