After U.S. Health and Human Services Secretary Tom Price's news conference Thursday morning, Sen. Bob Corker greeted a faint breeze of a protest.
Standing in front of the Council for Alcohol & Drug Abuse Services on Spears Avenue, Corker spotted four pro-Obamacare signs — and two people. Anna Grabowski, 63, asked why congressmen didn't draft a single-payer health care reform plan. Corker didn't bite.
But Eric Reese, 37, told the senator that his conservative colleagues in Washington were going to put together a plan that is simply too harsh for the poor and the deathly ill. To that, Corker offered a rebuttal.
"There is no attempt to do away with the pre-existing condition issue (in place under the Affordable Care Act)," he said. "There is an attempt right now to build up the subsidy level so that people who are lower income can actually purchase health care."
"Do right by us" said Reese, who told the Times Free Press he makes about $8,000 a year delivering pizzas.
"All right," Corker said. "I will."
The whole interaction lasted about two minutes before Corker left. But his statement, to just a couple of people on the sidewalk, touched on two key debates concerning the health care reform bill passed in the House in May — and its Senate counterpart introduced two weeks ago.
What protections should the government enforce for people with life-threatening diseases? And how generous should the law be for those barely hovering above the poverty line?
On Thursday afternoon, a spokesman for Corker, R-Tenn., said the Senate bill needs to become more generous to the poor.
"The levels (of subsidies) in the discussion draft were still not adequate to allow low-income citizens to purchase appropriate health care," said Micah Johnson, Corker's communications director.
U.S. Sen. Lamar Alexander, R-Tenn., also said the Senate's bill needs to provide more assistance to the poor. He said 168,000 low-income Tennessee residents don't have health insurance right now and that 6 percent of insured people in the state purchased health care through the marketplace — including 25,000 in the greater Chattanooga area.
Alexander would like to see more federal money appropriated to the State Stability Fund, a block grant under the reform bill for at-risk groups. According to the Senate's current discussion draft, the bill would set aside about $12 billion a year from 2019 to 2021.
"I'm working to ensure that the draft Senate health care bill has enough funding to help those lower income Tennesseans in the individual market be able to buy a reasonable health insurance policy," Alexander said in a statement. "One way or the other, we are going to have to deal with these two groups of Tennesseans [those without insurance and those who get insurance through the marketplace], because it is not right to leave either group worrying about whether they are going to be able to have health care coverage."
Pre-existing condition issue
Corker said congressmen do not want to gut the Affordable Care Act's pre-existing condition mandate, which blocks insurance companies from denying coverage simply because of health problems. And indeed, the Senate's bill says just that.
But some health care analysts argue the bill still strains people with devastating illnesses. They point to one element of the reform: how states can petition to abandon Affordable Care Act mandates.
Currently, when state leaders apply for those waivers, they have to prove they are still going to place some restrictions on health insurers. This includes a promise that insurance in their states will still cover "essential health benefits," a set of 10 different health categories that include maternity care, mental health services and substance abuse treatment.
Under the Senate bill, states would no longer have to promise they would force insurance companies to provide those benefits.
"It is not accurate to say [the proposal] maintains protections for people with pre-existing conditions," said JoAnn Volk, a research professor at Georgetown University's Center on Health Insurance Reforms. "They absolutely will find that their coverage puts people at risk."
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, called the tweak in the Senate bill a "backdoor" cut to the pre-existing condition mandate. She and Volk both described the following scenario: The insurance companies will accept a cancer patient in a relatively affordable pool alongside younger, healthier people. However, that plan will not cover chemotherapy.
Instead, both said, the cancer patient will have to enroll in a more expensive pool to get the treatment they need.
Lindsay Boyd, the policy director for the Beacon Center, argued that essential health benefits mandate is the main culprit for premium increases under the Affordable Care Act. According to HHS, premiums for a family of four with a silver health care plan increased on average from $9,500 in 2014 to $13,000 in 2017 — a 38 percent jump.
"The primary driver for that massive cost increase has been those essential health benefits," she said. "They simply don't make sense for most Americans."
Boyd said state officials should be free to impose "more creative, innovative solutions" for high-risk populations. On Thursday, she floated out ideas like work requirement laws for health care and direct primary care models, in which doctors can charge a monthly or annual fee for all services to a patient.
While Corker and Alexander both said there should be more support for low-income patients, Boyd criticized the current Senate bill for its use of tax credits on health insurance, which she dubbed "corporate welfare."
Under the Affordable Care Act, insurance shoppers are eligible for some sort of subsidy when they earn annual incomes at 100-400 percent of the federal poverty line. This year, for a single-person household, that range tops out at $48,240. Authors of the Affordable Care Act aimed to cover people earning less than the poverty line ($12,060 for a single-person household) through Medicaid expansion, though officials in some states denied that offer.
Under the Senate's plan, subsidies would be offered for people earning no annual income, up to 350 percent of the poverty line. The total amount for the proposed subsidy would be based on a formula that factors in age and income. In general, younger people would pay less.
For example, Pollitz said, a 24-year-old just barely eligible for a subsidy would have to pay the insurance company a rate of 6.4 percent of his or her annual income. A 64-year-old, on the other hand, would pay a rate of 16.2 percent.
And while Boyd believes the subsidies, on principle, give away too much, Pollitz said the current draft doesn't offer enough. If someone is at the poverty level, she said, they would pay $20 a month. But they wouldn't meet their deductible until they spent $7,000.
"They wouldn't be able to afford to use it," she said. "Effectively, it wouldn't work."
Contact Staff Writer Tyler Jett at 423-757-6476 or firstname.lastname@example.org. Follow him on Twitter @LetsJett.
CORRECTION: An earlier version of this story said 64 year olds at the upper level threshold of subsidies would pay 9.5 percent of their income for insurance. The rate should be 16.2 percent, according to Karen Pollitz at the Kaiser Family Foundation.