Angry over the bill — A Tennessee woman hated that her congressman voted for the controversial Republican health care bill in the House of Representatives, authorities say.

So Wendi Wright tried to run Rep. David Kustoff, R-Tenn., off the road after he left a town hall meeting at the University of Tennessee at Martin, they said. The Weakley County Sheriff’s Department said Wright tailed the car carrying Kustoff. At some point, the congressman and his aide became afraid and worried that Wright wanted to force them off the road.

They then turned into a driveway and stopped. That’s where Wright got out, screamed at the congressman and struck the windows of his vehicle, even reaching inside the car, the sheriff’s department said. Authorities said Wright then stood in front of the vehicle to try to keep Kustoff from leaving. At some point, someone called 911, but Wright left before authorities arrived.

The incident happened May 8, four days after House Republicans narrowly passed a bill to overhaul the country’s health care system.

Wright, 35, has been charged with felony reckless endangerment and was released on bond.

— The Washington Post

Johanna Hershenson’s health insurance, which she affords with the help of tax subsidies provided under the Affordable Care Act, is paying for the “overwhelming majority” of her breast cancer treatment, including acupuncture, which she credits with preventing the painful nerve damage that often accompanies aggressive chemotherapy regimens.

But the House’s passage of the American Health Care Act earlier this month, which could affect coverage for pre-existing conditions including cancer, has her worried. Not only for herself but also for her daughters, 20-year-old Zoe and 17-year-old Abi.

Hershenson has a genetic mutation that made her likely to develop breast cancer. Her daughters have a 50 percent chance of having the same mutation.

“Medically, I’m advised to know this information,” said Hershenson, 48, of Bend. “But why in the world would I subject them to having this information documented when pre-existing conditions are on the cutting block?”

House Republicans narrowly passed the newest version of their contentious ACA replacement plan May 4 after a previous iteration failed to garner enough votes. Now that the plan is one step closer to passage, states like Oregon are wondering how it would fit into a complex health care landscape in which scarce resources are at odds with a progressive political majority. Perhaps the biggest difference between a previous iteration of the AHCA and the version the House approved is the new one allows states to opt out of the ACA provision that prevents insurers from charging people more if they have pre-existing conditions.

States could also opt out of a provision that requires insurers to cover 10 essential health benefits, including preventive services, mental health, maternity care and prescription drugs.

Republicans can’t undo the ACA provision that requires coverage for pre-existing conditions, but allowing insurers to charge more could have the same result if the coverage becomes unaffordable, said Jeff Luck, associate professor of health management and policy at Oregon State University.

“Effectively, if the price is too high, it’s not a practical offer of coverage,” he said.

Given the progressive stance Oregon’s elected officials have taken around health care, opting out of those ACA provisions would likely be a “last resort” here, Luck said.

Pat Allen, the director of Oregon’s Department of Consumer and Business Services, the agency that regulates private insurance in the state, declined to speculate on whether Oregon’s Legislature and governor would choose to opt out of those provisions. On a broad level, he said Oregon’s leaders will evaluate what comes down at the federal level and make decisions then.

For her part, Hershenson said she feels safer in Oregon from being charged more for having cancer than she would in a different state.

“I’ll tell you, If I didn’t live in the state of Oregon, I’d be a hell of a lot more concerned,” she said.

State flexibility

U.S. Rep. Greg Walden, a Republican who represents Oregon’s 2nd Congressional District, described several aspects of the plan he helped craft as providing states with more flexibility to determine what works best for them.

For example, the ACA limits the amount insurers can charge older adults to three times that which they charge young people. The AHCA would allow insurers to charge older customers five times more than younger customers.

A January analysis from the actuarial firm Milliman found that going from three-to-one to five-to-one age pricing would increase monthly premiums in 2018 for people 60 and older by an average of 22 percent. For people ages 20 to 29, prices would decrease by 15 percent, on average.

The caveat, though, is that states could move their brackets back to three-to-one if that works better for them, Walden said.

“They’ll have that flexibility to actually manage the market to fit the population and their citizens,” he said, “which I think is a lot better approach than the federal government saying, ‘This is it. We’re smarter than you are. Take it or leave it.’”

The goal behind the five-to-one age pricing is to encourage more young, healthy people to buy policies that they currently find too expensive, Walden said.

“They’re writing a check to the (Internal Revenue Service) rather than buying insurance, or they’re getting a hardship exemption,” he said.

States that choose to let insurers charge sick people more could draw from a pool of money the AHCA establishes specifically for high-risk individuals. The AHCA proposes allocating $8 billion to that fund over the next five years to cover all states.

Oregon operated its own program to cover people with pre-existing conditions prior to the passage of the ACA. The program was funded by $70 million to $90 million in annual payments from insurance companies and enrollee premiums, Allen said.

“That’s far, far more than what’s being offered in the AHCA,” he said.

Walden disputed the idea that the AHCA’s high-risk funding wouldn’t be enough money to cover Oregonians with pre-existing conditions, pointing to another pool of money the bill creates that the state could put toward expensive patients.

The AHCA would dedicate $130 billion over the next nine years to what’s called a Patient and State Stability Fund, which is designed to stabilize states’ insurance markets. States could use the money as they see fit, whether that’s to reduce premiums for people buying individual market policies or to encourage insurers to sell in certain markets.

In any case, Walden said he doesn’t foresee Oregon needing to use the high-risk pool funding, as he doesn’t believe the state will seek a waiver from the ACA provisions.

“I can’t imagine us waiving some of this as Oregonians,” he said. “I just wouldn’t see it happening.”

Penalties

Several other important provisions of the AHCA are unchanged from previous versions. The new version still eliminates tax penalties for not having coverage and lets insurers charge people 30 percent higher rates for having lapses in coverage longer than 63 days.

Under the ACA, tax penalties for not having coverage are based on income, so low-income people pay lower penalties. Under the AHCA, they would be based on premiums. In effect, that means people with high incomes would pay lower penalties under the AHCA compared with current penalties under the ACA.

A 50-year-old who made $95,040 in 2016, for example, would pay a $2,117 penalty for not having insurance under current law. Under the AHCA, that person would pay $1,713 more for a bronze plan if he or she was not insured for 12 months previously. A 50-year-old who made $35,640 in 2016, by contrast, would pay a $695 penalty for not having coverage under current law, and $1,713 more for a bronze plan under the AHCA, according to an analysis by the consulting firm Avalere Health.

Tax subsidies to help people afford coverage would be based on age, not income, as they are currently.

Cuts to Medicaid are mostly unchanged in the newest version of the AHCA. Oregon officials released a report in March that said under the AHCA, up to 375,000 people on the state’s Medicaid program would lose coverage by 2023, largely because the state would no longer be able to afford to cover them.

Walden said he disagrees with that figure because it assumes the state would not change which services are covered under its “robust” program, which he noted covers dental care and vision with almost no out-of-pocket costs.

“I think the state can be more inventive than that, frankly,” he said.

The recent version of the AHCA would also allow states to obtain work requirements for nonelderly, nondisabled, nonpregnant adults covered under their Medicaid programs, a move Walden said he supports.

“It’s worked in welfare,” he said. “The best thing we can do is help people get a good-paying job that has insurance benefits.”

The Congressional Budget Office announced it will release a report on the newest version of the AHCA during the week of May 22. Meanwhile, senators are crafting their own ACA replacement. If that one is approved, the two versions will go through a reconciliation process.

Hershenson, who works part time as a rabbi, doesn’t look fondly upon the insurance market before the ACA. She and her family couldn’t afford to buy insurance in 2010. That year, insurers had tried to put her in a high-risk group and charge her more because of her prescription for antidepressants. The following year, she kept her prescription information to herself.

“I lied and didn’t tell them that I took antidepressants and we got catastrophic insurance,” she said. “Great lesson for the kids, isn’t it?”

Hershenson was upset when she watched Rep. Mo Brooks, a Republican from Alabama, claim on national television that “people who live good lives” don’t get pre-existing conditions. She describes herself as an extremely fit, health-conscious person. Her breast cancer was genetic.

“It’s horrifying to me,” she said. “And you know what? It’s mean. I find it so mean.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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