Trump administration complicates efforts of Republicans to show support for preexisting condition protections


New actions from the Trump administration are complicating efforts of vulnerable Republicans to show their support for preexisting condition protections heading into Tuesday's midterm elections.

The Trump administration moved last week to allow states to waive certain ObamaCare requirements and pursue conservative health policies that were previously not allowed under the Obama administration.

“States know much better than the federal government how their markets work,” Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said at the time. “We are making sure that they have the ability to adopt innovative strategies to reduce costs for Americans, while providing higher quality options.”

The new rules would allow states to promote health plans that don’t require the same level of coverage as the federal health law, including charging people with pre-existing conditions more money.

But while Trump administration officials touted the new rules as a major victory for state flexibility and innovation, the change also forced already embattled Republicans to parry heightened attacks from Democrats accusing them of wanting to take away the protections.

The entangling political dynamics were no more on display this week than in Wisconsin where Republican Gov. Scott Walker, who is locked in a tight reelection battle, announced that he was willing to adopt ObamaCare’s pre-existing protection language verbatim.

“People want to know, they want to hear it directly from me that we will always cover people with pre-existing conditions," Walker told reporters, according to the Milwaukee Journal Sentinel.

“No matter what happens in the courts or in the Congress, in Wisconsin we'll codify that, the exact same language that's in the Affordable Care Act, we'll make sure that everyone living with pre-existing conditions is covered here in the state,” Walker said.

It was a dramatic about-face for Walker, who has spent the past eight years disparaging the health law. But the two-term incumbent is essentially tied with Democrat Tony Evers ahead of Tuesday’s election, and polling shows overwhelming support for pre-existing condition protections.

“Walker is trying to not be on the wrong side of the issue,” said Charles Franklin, director of the Marquette Law School Poll. “He’s embracing the exact language of a bill he campaigned against for eight years.”

Yet even as Walker was declaring his support for the most popular parts of ObamaCare, the Trump administration announced it had approved Walker’s request to change Medicaid to impose work requirements and charge premiums for some of the poorest people in the state.

Unlike in other states that instituted Medicaid work requirements like Arkansas or Kentucky, there was no in-person rollout.

Walker did not appear with administration officials to tout the announcement.

In a statement and during a campaign stop Wednesday, Walker defended the moves, saying the restrictions will prepare Medicaid beneficiaries to enter the job market.

“With more people working in Wisconsin than ever before, we can’t afford to have anyone on the sidelines: we need everyone in the game,” he said.

Franklin said work requirements have historically been popular in Wisconsin for welfare programs like food stamps, but Democrats can tie the Medicaid waiver to coverage restrictions.

“Even though it’s disconnected from pre-existing conditions, it further undermines his position as a champion for unrestricted health coverage,” Franklin said. “While it might play to his past support for requiring work, at the moment, he doesn’t want to make that a key talking point."

While Walker's comments embracing a portion of ObamaCare are the most explicit a Republican has made on the topic, other Republicans have also been forced to defend their positions on the issue.

Missouri GOP Senate candidate Josh Hawley released a campaign ad this fall saying his oldest son has a rare chronic disease, and he supports "forcing insurance companies to cover all preexisting conditions."

Hawley is among the 20 conservative state attorneys general fighting in federal court to invalidate those protections. He's said he has no regrets about being part of the lawsuit.

Rep. Martha McSally (R), who is running to replace retiring Sen. Jeff Flake (R) in Arizona, said in an ad she is "leading the fight" to "force insurance companies to cover pre-existing conditions."

Yet McSally voted for a GOP ObamaCare repeal bill last year that would have allowed states to repeal ObamaCare's protection against premium spikes on people with pre-existing conditions.

In Wisconsin, Evers has been hammering Walker for his refusal to expand Medicaid. His first television ad of the campaign accused Walker of playing politics during his 2016 presidential run by refusing to accept federal money to expand coverage.

The Democratic candidate has not weighed in on the work requirement issue but he blasted Walker’s comments on ObamaCare. The administration's approval marks the first time a non-expansion state has been given permission to impose the work requirements.

“Actions speak louder than words, folks,” Evers said in a statement. “The fact is that Scott Walker spent the past eight years trying to repeal the Affordable Care Act and its protections for pre-existing conditions.”

Health advocates said they’re worried the new Trump administration requirements will disproportionately impact people with pre-existing conditions, allowing states to enact policies that the advocates say counter the law's intentions.

While the new policy doesn’t explicitly mention people with pre-existing conditions, those are the ones who traditionally rely on Medicaid, said Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities.

“The waiver would disproportionately harm people with pre-existing conditions,” Katch said. “When you think of people who have incomes below the poverty level, its because they struggle with conditions that prevent them from working,” like severe diabetes and opioid addiction, she said.

Despite Walker's pronouncement about adopting ObamaCare language, Katch noted that the GOP governor has not asked the state to withdraw from a federal lawsuit that would invalidate those very protections.

The Medicaid changes are “very much consistent” with wanting to undermine the law, Katch said.

For his part, President Trump has sought to defend Republicans up for reelection this year while rebuffing Democratic attacks over pre-existing conditions.

Just days after the administration's latest ObamaCare move was announced, Trump ignored any mention of it. He instead took to Twitter to argue that he and the Republicans are the only ones who want to protect pre-existing conditions.

“Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican,” Trump tweeted.

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