Health Coverage for People with Diabetes in Doubt with AHCA Vote

Update – 4:17 p.m. – 3/24/2017 – House Speaker Paul Ryan has pulled this bill from the House floor. The AHCA is considered dead at the moment. 

In last-minute negotiations between Republican factions over the fate of the American Health Care Act (AHCA), the right for people with diabetes to have health insurance became a bargaining chip.

The House of Representatives was supposed to vote Thursday on the AHCA to repeal and replace the Affordable Care Act, but House Majority Leader Paul Ryan and Trump administration officials knew they lacked the votes for it to pass. While Republicans have a majority in the House, they need to vote as a block, with few defectors, to get the legislation passed, as Democrats were set to vote against the AHCA. However, the most conservative wing of the Republicans in the House were balking at voting for the legislation, saying it didn’t do enough to reduce taxes and government spending or to deregulate the health care industry.

Both Wednesday and Thursday, Speaker Ryan and President Donald Trump tried to win over reluctant conservatives to the AHCA. They began to offer a series of amendments to the bill to make it more enticing to these lawmakers, according to multiple media accounts. This included a repeal of a requirement that all insurance plans must offer 10 “essential health benefits.” One of the benefits on the list was coverage for preexisting and chronic conditions.

You can learn more about the AHCA by reading “12 Takeaways About the House Plan to Repeal Obamacare”.

If the essential health benefits requirement is repealed along with the Affordable Care Act, then insurance companies would be under no obligation to provide insurance for people with diabetes. Critics of essential health benefits say that consumers who have no need for comprehensive insurance policies end up footing the bill for people who do. Defenders of the essential health benefits requirement say a repeal would drive up the price of insurance for all but the healthy.

Attempts to placate the most conservative lawmakers failed on Thursday. Some of this caucus still didn’t back the bill, despite the concessions offered. Other concessions offered to these conservatives alienated some more moderate Republican lawmakers. By day’s end, the number of Republican lawmakers tallied against the bill had grown, and Representative Ryan declared there would be no vote on the AHCA.

High-risk pools might be coming back if the AHCA passes. You can read about them here.

However, by evening, multiple news outlets reported that President Trump has declared that the AHCA must be voted upon Friday or it will lose his support. It’s unclear at this writing how many votes will move from the “no” column to the “yes” column because of this ultimatum. It’s just as unclear if the final version of the bill will include a guarantee of coverage for people with diabetes and others in the chronic care community.

Any bill passed by the House with these last-minute changes might run aground in the Senate. Lawmakers there passed rules saying that the repeal-and-replace effort must be done within certain budgetary rules to avoid a filibuster. Repealing essential benefits would likely not follow these rules and face a Democratic filibuster.

You can follow updates on the AHCA vote tally on these sites:
Fox News
Washington Post

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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