Rep. Dan Newhouse was absent for Thursday’s vote on the GOP plan to repeal and replace “Obamacare,” the sole member of the House to miss it.
Republicans needed 216 votes to pass the bill. They got 217.
Newhouse’s wife, Carol, has been receiving chemotherapy treatment for recurring cancer since February. In a statement posted on Newhouse’s Facebook page, he says he was unable to be present at the vote because of her health.
He had been an assumed “yes” vote on the bill.
Newhouse’s statement on Thursday’s vote, which drew more than 200 comments on his Facebook page, read in part: “For years, I have been hearing from Central Washington families who lost insurance that they wanted to keep and are now paying more for health care due to the Affordable Care Act. Their stories of paying higher prices for insurance and higher deductibles with limited insurance options have been the reason I have voted in the past to repeal Obamacare along with its mandate and bureaucratic regulations.”
Democratic Sen. Patty Murray relayed a different experience with constituents.
“People across our state are coming up to me with tears in their eyes, worried about what the Republicans’ bill would mean for them and their families, and many of them are people who gained coverage as a result of the Medicaid expansion,” she said in a statement.
Democratic Sen. Maria Cantwell also released a statement decrying the bill’s passage. “The saddest part is that (the GOP) health care plan is a disaster and they know it,” she wrote.
Two of the biggest concerns in the GOP bill are cuts to Medicaid and the lack of certainty over coverage for people with pre-existing conditions.
Two Washington Republicans, Reps. Dave Reichert and Jaime Herrera-Beutler, voted against the bill.
In the past, Newhouse has stated his support for maintaining protections for people with pre-existing conditions. But the GOP’s plan does not explicitly ensure those protections.
A recent amendment added to the Republicans’ American Health Care Act by Rep. Tom MacArthur would allow states to seek a waiver on the Obamacare provisions that require all health plans to cover certain essential benefits, and that prohibit plans from charging people more based on their health status.
If a state waived those requirements, insurance companies would be free to raise the price of health coverage for individuals with existing health problems, such as diabetes. If the plan got too expensive for those individuals to afford, causing them to lose coverage, they could be denied access to other health plans on the basis of their pre-existing condition, or be priced out of the market.
The MacArthur amendment requires that states would either have to set up a high-risk pool for such individuals, or use a new federal risk-sharing program to help reimburse insurers for covering high-risk patients.
But health care stakeholders such as the American Medical Association say there is still no guarantee in the GOP bill that coverage would be affordable for those with pre-existing conditions.
Newhouse’s office did not respond to questions about how he would ensure that protections for people with pre-existing conditions remain in place, if Washington state were to seek a waiver.
The GOP bill also would cut Medicaid by $880 billion over the next decade, which the Congressional Budget Office in March estimated would cause millions of people to lose coverage.
This provision would hit Central Washington especially hard, says Dr. Mike Maples, CEO of Community Health of Central Washington, one of three federally qualified health centers in Yakima County designed to care primarily for low-income patients and those who lack insurance.
In 2016, Maples said, the eight community health centers in Newhouse’s district (which stretches from the Oregon border south of the Tri-Cities all the way to the Canadian border) served 251,000 individuals.
And according to the latest state Health Care Authority enrollment report from April, 97,931 of Yakima County’s roughly 250,000 residents, including children, are covered by Medicaid programs.
That’s nearly 40 percent of the county’s population.
The current bill was pushed through the House without a CBO score, and details have been sparse, Maples said. “So it’s hard to put much detail or put numbers to it, except that it’s clear that people would lose coverage.”
People who don’t have health coverage are a lot harder to treat than people who do, Maples said. While Community Health and other health centers offer sliding fee discounts based on income, if they need to refer patients out to specialists or other services, those services are likely unaffordable out-of-pocket.
“I haven’t seen anything in this bill that I think makes it an improvement” over the ACA, he said.
As for insurers, the national Association of Health Insurance Plans issued a statement Thursday, saying that the GOP bill “includes key provisions to stabilize the market in 2018 and 2019” but that the Senate needs to make significant changes to provide certainty on tax credits and subsidies for health plans; establish better protections for those with pre-existing conditions; and ensure adequate resources for state Medicaid programs.
“We still have to see what the Senate does with it,” Maples said. “Hope springs eternal.”