David Marcus

Martha McSally provided crucial support to efforts to pass the American Health Care Act (AHCA) this week in the House of Representatives. With the theme from “Rocky” blaring in the background, McSally famously urged her Republican colleagues the morning of the vote to “get this (bleeping) thing done.” McSally also takes credit for a “fix” that purportedly corrects one of the AHCA’s most egregious aspects and thus smoothed the bill’s passage.

Don’t be fooled. McSally’s “fix” demonstrates her insincerity, not her good faith.

The “fix” involves one of Obamacare’s important provisions. Before Obamacare went into effect, congress members, like most Americans, enjoyed employer-based health insurance. Obamacare made a change. It requires congress members to buy their insurance on the exchanges that the law set up in each state for people who do not get their insurance through large employer plans.

This provision of Obamacare is important. It ensures that congress members fare no better or worse when they shop for health care than ordinary Americans do when they get their insurance through the exchanges. The provision aligns incentives: If Obamacare is bad for the country, it is bad for congress members. Likewise, if congress members want to make their health insurance better, they must make it better for their constituents as well.

The AHCA would allow states to opt out of Obamacare rules that require insurance plans offered on state exchanges to provide essential health benefits, such as coverage for emergency and maternity care. The AHCA would also permit states to opt out of Obamacare rules that prohibit these plans from discriminating against people with pre-existing conditions. If Arizona opts out of these Obamacare rules, health insurance costs will explode for cancer survivors, people with arthritis and anyone recovering from an addiction – all preexisting conditions.

If the AHCA is so bad, why would congress members support it when they might have to pay much more for their own health care? This is the point of the Obamacare provision – to align incentives.

Here’s where the AHCA gets outrageous. The AHCA requires insurers to continue to offer insurance to congress members as if the Obamacare rules regarding essential health benefits and preexisting conditions remain in place, regardless of what states do. In other words, the AHCA exempts congress members if their states opt out of the Obamacare rules. A cancer survivor who gets insurance on an exchange would have to pay astronomical sums for her health insurance if her state opts out. A congress member who survives cancer would not.

After the media discovered that the AHCA would still guarantee congress members affordable insurance, regardless of what their states do, McSally quickly introduced a separate bill to remove the exemption. She solemnly tweeted, “lawmakers are not above the law” upon her bill’s passage.

But McSally’s fix is phony and does nothing to ensure that incentives stay aligned.

Because congress members work in the District of Columbia, they can buy health insurance on a D.C. exchange. Unlike, say, Arizona, where state legislators have railed against Obamacare for years, the D.C. district government is very progressive. The chances that it will opt out of Obamacare rules are zero.

If the AHCA passes, and if Arizona opts out, McSally can still buy her insurance on a D.C. exchange. She will have plans available to her that must cover essential health benefits and that cannot charge her more if she has a pre-existing condition. An Arizonan who suffers from anxiety or heart disease has a pre-existing condition. He or she will not have McSally’s option.

If McSally had confidence in the AHCA, her fix would have required congress members to buy insurance on their home states’ exchanges. She would then have to suffer the consequences if Arizona opts out of the Obamacare rules. But McSally will continue to have access to good, affordable health insurance, no matter what happens to her constituents.

McSally is willing to gamble with her constituents’ healthcare but not her own. This is shameful.

David Marcus is a law professor living in Tucson. Contact Marcus at david_marcus@hotmail.com.