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After Key Role in Getting AHCA Through House, MacArthur Weathers the Storm

Mary Caffrey
The creator of the compromise that pushed the Obamacare replacement past its first hurdle withstood hours of jeers from angry constituents, as he tried to present the nuances of a plan to shore up the individual health insurance market.
Two months ago, US Representative Tom MacArthur was an insurance executive turned second-term congressman still working on name recognition within New Jersey, let alone outside it. But last week, the Republican brokered the compromise that got the American Health Care Act (AHCA) through the House of Representatives, and the amendment will likely define him—for good or ill, depending on your point of view.

While his fellow Republicans celebrated “the MacArthur amendment” with President Donald J. Trump at the White House, hundreds of rowdy constituents and protesters had a different take on MacArthur’s efforts last night in Willingboro, NJ, where the congressman held a town hall meeting in perhaps the most Democrat-leaning community in his district—by his own count, only 9% voted for Trump last fall, and, “I crushed it with 12%.”

Just to get to the municipal building, MacArthur passed banners and bullhorns, a costumed Grim Reaper, and a cast of protesters who created an AHCA “graveyard” in the parking lot. Beyond the theatrics were several of MacArthur’s own constituents, Medicare-age baby boomers from the graying Philadelphia suburbs on the west side of a very divided swing district.

There was a sense of worry among some individuals in attendance, such as Jan Pilenza of Delran, whose husband is finishing up treatment for non-Hodgkins lymphoma and has had good experience with their supplemental Medicare coverage, who worries what could happen if things changed; or Peter and Robin Bilazarian, a mathematician and a social worker at Cooper University Medical Center in Camden who both take issue with the way MacArthur has presented the AHCA’s overall Medicaid funding in his constituent communications.

Peter said MacArthur’s plan will cost thousands of people in the district Medicaid coverage, affecting hospitals like the one where Robin works, which serves many of the region’s poor. Besides, Robin added, “Doesn’t everybody have a preexisting condition?”

How preexisting conditions will be treated under the MacArthur amendment was a focal point last night in New Jersey and across the country. The congressman spent considerable time trying to explain the nuances of his idea: the state-level waivers under the AHCA do not, he insisted, mean people with preexisting conditions will not be able to get coverage. They mean that only the 7% in the individual market with a lapse in coverage—of 63 days—could face higher costs, but they would find coverage through a high-risk pool that states would be required to set up.

MacArthur sees his solution as the best way to balance several goals: choice in the individual market is drying up, and young people are not buying coverage because it’s too expensive. He believes his plan will lower costs and draw price-sensitive young adults into the market, while providing a mechanism for those with high-cost conditions to get insurance.

Another New Jersey Congressman, Representative Rodney Frelinghuysen, also voted for the AHCA on the belief that the Affordable Care Act (ACA) is "collapsing" with New Jersey families facing "skyrocketing premiums, soaring deductibles, and fewer choices." Frelinghuysen said in a statement that MacArthur's compromise was the best path forward.

"The earlier version of the House-proposed American Health Care Act was unacceptable to me," he said. "Today, I want to reassure New Jersey families that this legislation protects those with preexisting conditions and restores essential health benefits. I voted to move this bill to the US Senate, which will have the opportunity to improve this legislation significantly."

Frelinghuysen said that he expects the Senate will return a better proposal and will make significant changes to what he considers an "imperfect product." Furthermore, he added that while the ACA was "well-intentioned," it had "failed," which is something that MacArthur mentioned in his town hall.

“If you are in the individual market, if you have coverage today, your premiums and deductibles have increased,” MacArthur said. For those who don’t get coverage through their employer, Medicare, or Medicaid, “Those people are not going to be able to find insurance policies if we don’t act.”

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