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Fact-Checking Republicans' Defense Of The GOP Health Bill

People attending Rep. Rod Blum's town hall event in Dubuque, Iowa, this week held up red sheets of paper to show disagreement with what the Republican congressman was saying and green to show they concurred. The GOP health care bill was a major concern of many.
Scott Olson
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People attending Rep. Rod Blum's town hall event in Dubuque, Iowa, this week held up red sheets of paper to show disagreement with what the Republican congressman was saying and green to show they concurred. The GOP health care bill was a major concern of many.

Town hall meetings got loud for some Republican members of Congress this week, as they defended the passage of the American Health Care Act by the House of Representatives. Constituents have been asking a lot of questions, and we've been fact-checking the answers given by some leading GOP lawmakers.

Tom Reed, R-N.Y., at a town hall meeting in his district

"The pre-existing reform is not repealed by this legislation."

Fact check: That's not the whole truth

Reed was responding to a constituent who was concerned about a child with severe allergies: "His co-pays and deductibles will be through the roof," the parent told Reed, "because he's going to be in a high-risk pool — because he has a pre-existing condition."

"No, no, no," Reed told the parent.

The bill does have language that says insurers cannot deny people coverage or charge them more just because they have a pre-existing condition.

However, the GOP bill also has an enormous loophole in that regard. The plan allows states to apply for waivers from the federal government that get them out of many of the regulations put in place under the Affordable Care Act — including one that bans insurance companies from charging people with pre-existing conditions more for a health plan. A waiver would allow insurance companies to consider a person's health status when determining what to charge for coverage. And that means that although someone with a pre-existing condition who lives in a state that got a waiver would have to be offered a policy, it could be very expensive.

Steve Scalise, R-La., on Fox News this week

"No matter what kind of plan you have today," Scalise told Fox News, "if you have a pre-existing condition, under our bill, you cannot be denied coverage and you cannot be charged more than anybody else."

Fact check: Not exactly true

Scalise, like Reed, is pointing to the language in the bill that retains the Obamacare rules that prohibit insurers from charging people with expensive medical conditions more than their neighbors of the same age for an insurance policy.

But the state waivers allow insurers a way around that guarantee.

Before the Affordable Care Act, insurance companies denied coverage or charged more if the person who wanted insurance had any of a long list of conditions — including arthritis, diabetes, heart disease, muscular dystrophy, obesity and sleep apnea, according to a list compiled by the Kaiser Family Foundation from insurers' underwriting guidelines.

Insurers also could refuse to cover many medications, including drugs that treat cancer, diabetes, AIDS or arthritis, according to Kaiser.

If you have cancer and buy insurance that doesn't pay for your cancer treatment, your pre-existing condition is effectively excluded.

Rod Blum, R-Iowa, at a town hall in Dubuque

"If you're getting your insurance through the group health care marketplace — your employer — nothing changes," Blum told constituents this week. "If you're getting your health insurance through Medicare, nothing's going to change. If you're currently getting your health insurance through Medicaid, nothing's going to change."

Fact check: Partly false

Blum's statement refers to a couple of big things — employer coverage and Medicaid.

As to employer coverage, whether your insurance would change under the GOP bill depends on whether your company is based — and buys its insurance — in a state that gets a waiver.

In "waiver states," employers' insurance policies might no longer be subject to Obamacare regulations around so-called essential health benefits — the minimal benefits that must be included in a policy.

They also might no longer be subject to restrictions on annual and lifetime spending caps.

That means, in those states, your employer-sponsored health insurance policy could deny coverage for some categories of care, such as mental health care or maternity coverage. And the health plan could impose annual or lifetime limits on insurance benefits. So workers with very expensive conditions, or their family members with such conditions, could see their costs pile up — even if they have health coverage through work.

Before Obamacare, about 60 percentof employers had lifetime limits on their health plans.

Blum's second statement — the one in regard to Medicaid — is false. The GOP health bill makes major changes to Medicaid, first by rolling back the expansion of the program over time.

The bill allows people to keep their expanded Medicaid as long as they remain eligible. But people at or near the poverty level often see their incomes fluctuate, making them temporarily ineligible for the health care program. Under the GOP bill, once they leave the Medicaid rolls, they likely would not be able to return, even if their income declines. That's because the federal government would pay a lower share of their costs and most analysts --including those at the Congressional Budget Office-- believe that most states are unlikely to continue the expanded coverage at the higher cost.

In addition, the bill fundamentally changes how the U.S. government finances Medicaid. States would receive a fixed amount of money from the federal government for each beneficiary, rather than an amount that varies according to the numbers of Medicaid beneficiaries and their health care needs.

Most analysts say that, over time, the level of services Medicaid could provide would decline if the GOP health bill becomes law, and the states would have to cut back on services. That forecast is borne out by the Congressional Budget Office, which said the changes to Medicaid would cut the costs of the program by $880 billion over 10 years.

Manyservices provided by Medicaid today, including home health care and services for people with disabilities, are considered "optional" under the GOP health bill. Those are also the services that help keep people out of hospitals and nursing homes.

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Corrected: May 10, 2017 at 10:00 PM MDT
An earlier version of this story said that under the GOP bill, once people leave the Medicaid rolls they would not be able to return, even if their income declines. In actuality, the bill does not bar their return, but they would probably lose that option because states would receive less funding for Medicaid when people leave the rolls.
Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.