5 Reactions to the Upton Amendment That Helped the AHCA

An amendment to the American Health Care Act (AHCA), introduced by Rep. Fred Upton (R-MI), promised $8 billion over a 5-year period to help fund health insurance for individuals with preexisting conditions. It was this amendment that helped swing the vote of moderate Republican House members in favor of passing the AHCA by a thin margin of 217-213.

The amendment has drawn mixed reactions. Here’s a glimpse:

1. Eight billion dollars is insufficient. Matthew Fielder, PhD, fellow at the Center for Health Policy at Brookings Institution, disagrees with how far the $8 billion would take us. He estimates that the total individual market claims over those 5 years will be about $500 billion, primarily from people with preexisting conditions.

2. The Center for American Progress (CAP) agrees. The AHCA originally provided $130 billion in funding for high-risk pools, which, according to CAP would not be enough for even a small population of high-risk individuals. According to the think tank, the additional $8 billion would subsidize coverage for only 76,000 people in the high-risk pool—for the estimated 1.5 million who fall in the high-risk pool, the AHCA would need to divert $327 billion in funding to provide moderately subsidized high-risk pool coverage. Upton’s amendment only fills 4% of the existing funding gap for the high-risk pool.

3. Premium surcharges for persons with chronic conditions. CAP data show that premium surcharges would skyrocket for individuals with certain health conditions, such as diabetes and cancer. A person with metastatic cancer would have a surcharge of $140,510, while a person with lung or brain cancer would be faced with a surcharge of $71,880. Patients with diabetes without complications would see a surcharge of $5510, according to CAP researchers.

4. Republican support. Rep. Tom MacArthur (R-NJ) said that the amendment “adds a little more protection” for people with preexisting conditions. Rep. Patrick McHenry (R-NC) agreed with MacArthur, saying that the amendment was helpful for a lot of Republican members. The 36-member Freedom Caucus, that drew blame for failure of the original AHCA, support the new bill. “As long as there's no policy changes—I think for us it's the flexibility that's the key, giving state the ability to seek the waiver,” said Rep. Jim Jordan, a member of the Freedom Caucus.

5. AAMC’s concerns. The Association of American Medical Colleges (AAMC) remains concerned with the AHCA. In a press release, AAMC’s president and CEO Darrell G. Kirch, MD, said that the amendment “does not protect access to affordable coverage” for individuals with preexisting conditions. “Patients will still be at risk, leaving those with cancer, congenital heart conditions, mental illness, or other needs with access to coverage they cannot afford,” the statement went on to say.