MIDLOTHIAN, Va.— “Read the bill. Read the bill,” Virginia Rep. Dave Brat told a group of reporters gathered backstage before his Tuesday night town hall in the Richmond suburbs. “It’s in bold. If you guys can’t read the bill, then I can’t help you.”
Brat was speaking about section 137(b) of the American Health Care Act, which he had printed out in large text. That section—“No Limiting Access To Coverage For Individuals With Preexisting Conditions”—reads: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.” This provision of the ACHA, of course, is rendered moot by the text of the MacArthur amendment, named for New Jersey Rep. Tom MacArthur, which allows states to opt out of certain essential health benefits as well as waive community ratings that provide cost protections for patients with pre-existing conditions.
Brat and his fellow far-right conservatives used all of their leverage to include these changes in the bill before it passed in the House last Thursday. He then spent his Tuesday evening downplaying these changes in front of 400 or so rowdy, mostly anti-AHCA constituents in a large church auditorium.
It’s true that the AHCA retains the Affordable Care Act’s guaranteed issue provision, which doesn’t allow insurers to flatly reject customers based on pre-existing conditions. It keeps that—and then gives states the option of stripping its efficacy. These are changes that the House Freedom Caucus, of which Brat is a devoted member, fought for. The hardest choice they had to make was in accepting compromise language that only made these changes optional.
But in defending the bill on home turf, Brat used that state optionality to distance himself from the changes that he and his Freedom Caucus wanted. When a reporter said that the House “got rid” of community rating, Brat shot back. “No we don’t, no, nooooo we don’t!” he said. “We don’t get rid of any of those regs. So we allow the states to opt out of some regs that they choose. None of those have been chosen yet.” He added, both with reporters and during the town hall, that no states have yet to take up the waiver and that it would be a political ordeal for them to do so. Set aside for the moment that the bill isn’t law yet. Shouldn’t Brat want states to take the waivers? Wasn’t that what he was fighting for?
When I spoke with attendees of Brat’s town hall, the first thing they’d say is yes, they were residents of Virginia’s 7th Congressional District. (In order to attend, they needed to register online with their address, and at the door they needed to show ID that matched the address.) The second thing they’d say is that they’re concerned about the MacArthur amendment’s treatment of protections for sick people.
Barb Michelson of Henrico was with her daughter, Julia Niedermaier, who has asthma and has to carry EpiPens with her. They are concerned that if Niedermaier loses her job, she won’t be able to find insurance. Michelson herself says she’s been denied coverage on the individual market prior to the ACA for “back issues” and was only able to get (expensive) coverage after her doctor wrote a letter to the insurance company attesting that the issues were behind her.
John and Peggy Taylor, from Midlothian, say they are “violently against” the AHCA. Peggy had previously been denied coverage over an episode of viral meningitis. One of their children has “severe” allergies that recently landed him in the emergency room.
Left to the mercies of an individual market without community rating requirements, insurers wouldn’t be allowed to deny any of these people insurance. They could just charge them much more if they had a lapse in coverage.
The town hall was a joint venture between Brat and Virginia state Sen. Amanda Chase, who spent most of the night trying and failing to quiet the crowd. As she introduced herself and went through her legislative achievements, the crowd grew impatient for the main event: berating their congressman for his recent health care vote. (The crowd, by a show of hands, was roughly 3-to-1 against the bill.) It only took a few minutes for Chase to reach her limit. “Do not talk over me, or you will be escorted out,” she said to a particularly rambunctious group in the middle section. They were, per Indivisible Guide recommendations, holding red signs that read “NOPE” or “SHAME,” which they’d hold up when they heard something they disliked. The signs were held up for most of the event.
A few minutes later, as the noise continued, Chase rose from her seat and addressed the disrupters in the middle: “This is my town hall now!”
None of these chidings worked particularly well. Later in the event, as Chase attempted the kindergarten technique of “we can’t continue until you’re quiet,” Brat piped in with his own suggestion. “If the people who are yelling are going to prevent other constituents from hearing,” he said, “I urge you others to do what you can to bring a little rational discourse.”
Brat said he agreed with the crowd that there should have been a final Congressional Budget Office score on the bill before the House voted but also suggested that the unscored amendments would have an “insignificant impact on the first CBO score.”
He kept referring to these amendments as just “two pages.” That’s about the length of the Upton amendment, named for Michigan Rep. Fred Upton, which adds a relatively miniscule $8 billion toward high-risk pools to help patients with pre-existing conditions afford coverage. The Upton amendment was mostly a PR move designed to give moderate Republicans cover for supporting the revised bill, and it probably will have little impact on the CBO score, now expected the week of May 22.
The Upton amendment was not what flipped Brat from a “no” to a “yes.” That was the eight-page MacArthur amendment, which has also not been scored. Throughout the evening, Brat consistently downplayed its significance. But if it’s so insignificant—on the CBO score, on coverage levels, on premiums, on everything—then why did Brat and the Freedom Caucus grind so hard, and face so much public and intraparty scrutiny, in order to win it?
The town hall was scheduled to last until 8:30 p.m. Eastern, and it didn’t go a second beyond that. “It was a complete and utter deflection,” Max Heyworth, of Goochland County, told me after the event. He described it as more of a “show of force” than a true conversation.
“This was not about giving honest answers,” he said. “This was about looking like he can take any kind of a beating and spinning that narrative afterwards.”