Senate Republicans Try to Balance Lower Premiums Against Pre-Existing Conditions


Senate Republicans want to balance state waivers for Obamacare regulations with more funding for Americans with pre-existing conditions.

Senator John Thune floated the idea of allowing states to obtain waivers for Obamacare regulations known as essential health benefits and community ratings. Essential health benefits mandate that health insurers provide services such as mental health, maternal care, and hospital visits. Community ratings mandate that health insurers cannot vary insurance premiums for individuals based on age, gender, location, or health status.

“I think there will be some authorities for states because, like the House, we want to give the states as much flexibility as possible,” said Thune.

A recent Congressional Budget Office report found that most Americans would experience lower average premiums if their state were to obtain waivers to rescind some or all of Obamacare’s essential health benefits and community ratings. States that make moderate changes to Obamacare regulations would have roughly 20 percent lower premiums in 2026 compared to Obamacare, and states that waived all of Obamacare’s health regulations would experience the lowest average health premiums.

The MacArthur Amendment for the American Health Care Act (AHCA) allowed states to waive certain Obamacare regulations. The amendment was a compromise, brokered between House Freedom Caucus chair Mark Meadows (R-NC) and former Tuesday Group co-chair Tom MacArthur (R-NJ), that garnered enough votes from moderates and conservatives to pass through the House.

A few Republican Senators remain opposed to the idea of waivers for Obamacare regulations, including Sen. Dan Sullivan (R-AK), who says that he wants to keep protections for Americans with pre-existing conditions.

Conservative Senators such as Ted Cruz (R-TX) want to implement state waivers so that consumers can purchase less expensive insurance.

“If we’re going to lower premiums, we have to give consumers flexibility to be able to purchase more affordable plans,” the Texas senator explained. “We have to give states flexibility to innovate to provide creative solutions so that those in need receive better care.”

Many GOP Senators wish to strike a balance, allowing states waivers on Obamacare regulations on the one hand, and adding more funding to high-risk pools to lower the cost of health insurance for people with pre-existing conditions on the other.

Sen. John Hoeven (R-ND) said, “We want states to have flexibility, but that’s why you need some kind of federal support or backstop like a risk pool or reinsurance so that people are comfortable that for chronic illness and pre-existing conditions, there’s going to be coverage there and that their premiums won’t become unaffordable.”

To pass through the Senate, Majority Leader Mitch McConnell (R-KY) has to balance the interests of the moderates against conservative lawmakers who want to lower the cost of premiums. Republicans have a 52 majority in the Senate, meaning that they can only afford to lose two votes if Vice President Mike Pence were to break the tie.

“As Senator McConnell likes to point out, with 50 Senators needing to agree on this bill, everybody’s in a strong position, so we can’t roll anybody, so we’re going to have to continue to talk about that issue and try to come to consensus,” Sen. Cornyn said. “There is no consensus yet.”