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

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.”

Even as MacArthur spoke, word came that the national insurer Aetna, rocked by the Department of Justice’s rejection of its merger with Humana and market uncertainty, would abandon its footprint in remaining ACA marketplaces for 2018. But as one audience member shouted, the exchanges have suffered, in part, because of years of sabotage from the Republicans. (Several insurers have sued the federal government over Congress’ decision to not fully fund risk corridors, which were intended to reimburse plans for unanticipated costs in the early years of the Affordable Care Act.)

The crowd ranged from skeptical to not buying anything MacArthur said. Not the veteran who’d had a kidney transplant, nor the mother with special needs children, or the father born with a cardiac condition. The father said that while New Jersey might not seek a waiver, this meant he could not move to a state like Texas. He said MacArthur would have to live with having saved the AHCA. “You brought it back from the dead," he said. "You own it.”

At one point, the crowd began chanting, “Single payer! Single payer!” MacArthur gave a long explanation of why this system worked in smaller nations, but was not suited to large ones like the United States. Giving “bureaucrats” too much power was a bad idea, he said.

The most heated exchange came when MacArthur took a question from 17-year-old Daisy Confoy of Wrightstown, NJ, who will enter Temple University next fall and noted she will be eligible to vote in the 2018 midterm elections. “Is rape considered a preexisting condition under your amendment?” she asked, pressing MacArthur for a “yes or no” answer.

MacArthur declined to answer directly, and Confoy persisted, until a security officer asked her to take a seat, to applause from a crowd. The question of whether rape and domestic abuse to women could prevent them from getting coverage under the AHCA is not just an issue in New Jersey, as a reporter got arrested in West Virginia for pressing HHS Secretary Tom Price, MD, on a similar question.

The congressman remained measured throughout, keeping the questions and answers flowing despite constant interruptions and jeers. He kept imploring the crowd to treat each other with respect, and reminding them that the part of his district “beyond the Pine Barrens” thinks differently than they do, and that he wants to hear from everyone. However, one older constituent told MacArthur that the nuances get lost when people who fear losing their healthcare see a party at the White House on TV.

The crowd remained contentious through much of the 5 hour meeting, with more than a dozen TV cameras pointed at the crowded room. Already, ads against MacArthur are running in Philadelphia markets, and scenes from last night’s session seem likely to appear in new ones.

“Is this what American politics is going to be?” MacArthur asked.