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House Rep Who Took on ACA Underwriting Rules Loses Seat

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For Democrats, ousting Rep. Tom MacArthur was the icing on the cake.

The New Jersey congressman — labeled “the face of the GOP’s health care repeal” by the liberal group Protect Our Care — lost his seat after Democratic former Obama administration official Andy Kim was declared the winner by the Associated Press Wednesday, following a lengthy count of ballots after the Nov. 6 election.

In 2017, MacArthur co-authored an amendment to a major Republican Affordable Care Act (ACA) change bill with Freedom Caucus Chairman Mark Meadows. The amendment to the bill, which supporters described as an “Obamacare replacement bill,” handed Democrats a potent campaign weapon. The measure allowed states to waive ACA rules prohibiting insurers from charging sick people more. Party leaders reluctantly adopted it to win conservative holdouts who tanked an earlier version of their bill — and it passed the House.

(Related: Health Insurance Bill Dealmaker Draws Fire From Both Sides)

Though the bill died in the Senate, it became the Democrats’ rallying point in their congressional campaigns, helping them flip Republican-held districts from California’s Orange County to Staten Island and win control of the House. Democratic candidates warned that the GOP effort threatened coverage for people suffering from illnesses like epilepsy or multiple sclerosis.

Lost Seats

“The Freedom Caucus forced changes which resulted in tens of millions of dollars in ads that were used to defeat House Republicans in competitive districts,” said GOP Rep. Ryan Costello of Pennsylvania, who voted against the GOP bill. “We lost seats because of what they did.”

Health care was a dominant issue in television advertising in the 2018 election, with more than 1.2 million ads mentioning it, almost three-quarters of them run by Democrats. That forced many Republican candidates to depict themselves as protectors of those with existing medical conditions even as they supported attempts to dismantle the Affordable Care Act.

Dozens of Democrats who challenged incumbent House Republicans made Obamacare, particularly the GOP’s efforts targeting its consumer protections, a central part of their campaigns. That includes Kim, who featured his son’s health issues in ads.

‘Deaf Ears’

Costello, who is retiring from the House, said the Freedom Caucus was warned that targeting those regulations would backfire, but that it “fell on deaf ears” with the group of hardliners. “All they did was turn suburban Republicans into collateral damage electorally to the point where we lost the majority,” Costello said. “And that and the president’s tone is to blame.”

Asked to respond to the remark by Costello, Meadows replied wryly: “Who??”

Meadows added in a follow-up text message: “Tom MacArthur did unbelievable work to lower premiums and cover pre-existing conditions. Any blame directed at him is misplaced.”

But some allies of House Republican leaders agree the amendment was a mistake.

“Protecting folks with pre-existing conditions is good policy and good politics. Removing those protections in the MacArthur-Meadows agreement handed Washington Democrats a powerful weapon, and they used it to hammer the most vulnerable House Republicans in the midterms,” said Michael Steel, a GOP strategist who served as a spokesman for former House Speaker John Boehner and outgoing Speaker Paul Ryan’s vice presidential bid in 2012.

Flipped Seats

MacArthur’s district was one of four GOP seats in New Jersey alone that Democrats captured. There are still eight House races unsettled with Democrats leading in four of them.

The legislation, known as the American Health Care Act, was the product of the party’s promise to repeal and replace Obamacare, which the GOP has repeated since the law was first passed in 2010. An initial version came to a halt in March after Freedom Caucus members defected, arguing it didn’t do enough to lower costs. That’s when MacArthur teamed up with Meadows to author the amendment, which they believed would relieve burdens on younger and healthier people who were enlisted by the Affordable Care Act to subsidize older and sicker people. The bill passed without any Democratic votes.

In House races, a plurality of voters cited health care as their top concern, and those voters backed Democrats by a margin of 75% to 23%, according to exit poll data reported by CNN. A Kaiser Family Foundation poll in August 2018 said 72% of Americans favor the ACA requirement forbidding insurers from charging sick people more for coverage.

Lead Role

“Tom MacArthur played a lead role in resurrecting the Republicans’ harmful health care repeal effort, which created the single biggest political liability for Republicans nationwide,” said Meredith Kelly, a spokeswoman for House Democrats’ campaign arm.

The passage of the Affordable Care Act in 2010 contributed to a towering red wave that cost the party 63 House seats later that year as Republican candidates blasted it as a costly and complicated expansion of government that would harm the health care system.

When they captured the majority, Republicans held dozens of votes to repeal or dismantle the law, but after winning the White House in 2016 they struggled to replace it in a way that didn’t also undo its most popular provisions. With Democrats set to take over the House in January, the focus is likely to shift from undoing the law to bolstering its marketplaces and addressing a variety of problems they’re facing across the country.

Dueling Visions

MacArthur’s re-election website said Obamacare was hurting more people than it was helping, and that the congressman “rolled up his sleeves and worked to improve access to care for millions of Americans without quality care.”

(Related: Health Market Needs Medical Underwriting, Analyst Says)

Kim’s website offered a different viewpoint: “Tom MacArthur single-handedly revived TrumpCare,” it said, “by authoring legislation that would have made it harder for people with cancer, heart disease, and other pre-existing conditions to get the care they need.”

California Democrat Josh Harder said he ran for Congress because his brother had a pre-existing illness and he was angry that his congressman, Republican Jeff Denham, backed a bill that may have threatened his health coverage. Harder defeated Denham in a close race in the Central Valley district.

Another casualty of the bill was Rep. Martha McSally of Arizona, who conceded defeat in her close Senate race on Monday night. She struggled to explain her support for the bill and insisted it wouldn’t adversely affect pre-existing conditions. Health care ranked as the top concern for voters in that race, and Sinema won them by a margin of 77% to 22%, according to exit polls published by CNN.

While most of the defeated House Republicans are relative moderates in swing districts, one conservative may have fallen prey to his own tactics. Virginia Rep. Dave Brat, a Freedom Caucus member, was among the holdouts who declined to support the Obamacare repeal bill until the addition of the MacArthur-Meadows amendment.

Democrat Abigail Spanberger cited that provision to hammer Brat’s vote as one that undid pre-existing condition rules. She narrowly defeated him in a Republican-leaning district.

— Read White House, GOP Leaders at Odds Over ACA Bill Vote Planson ThinkAdvisor.

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