How did a junior Republican congressman from New Jersey emerge this year as one of the most influential players in efforts to repeal and replace the Affordable Care Act?
Rep. Tom MacArthur is a former insurance executive and co-chairman of the Tuesday Group, which counts nearly 50 center-right House Republicans as members and has been described as a powerful counterweight to the more conservative Freedom Caucus.
MacArthur’s combination of industry experience and sway with his GOP colleagues quickly made him a point man in the negotiations between Republicans in Congress and the White House. The last few months, as he describes them, have been a blur of meetings with President Trump, Vice President Pence, House Speaker Paul Ryan and droves of colleagues.
A detail-oriented health care wonk from a swing district that covers portions of Burlington and Ocean counties, MacArthur initially opposed efforts to repeal Obamacare, voicing concerns that the process was being rushed and didn’t involve Democrats, but he ended up as the lone New Jersey congressperson to endorse a bill to replace Obamacare last month, out of seven Democrats and five Republicans.
That bill, the American Health Care Act, was pulled for lack of support last month. But Republicans continue to try to find common ground and get a bill past the finish line in the House.
In an interview Thursday, MacArthur defended his choice to support the AHCA, arguing that although millions have gained coverage under Obamacare, millions of others have been slapped with unaffordable premiums and punishing deductibles under the same law.
“I hear from the person who is afraid to lose health insurance, and I also hear from the person whose premium went up 80 percent and can’t afford insurance,” MacArthur said. “There’s a lot of confusion, there’s a lot of misinformation, and I’m trying to be the person who makes the bill better. If that makes me more vulnerable then so be it. I didn’t come here just to decorate a chair.”
Before the American Health Care Act went down in defeat last month, MacArthur successfully pushed for a series of amendments that would have added $165 billion to protect vulnerable populations: $90 billion to cover some people from age 50 to 64, $60 billion for elderly and disabled people on Medicaid, and $15 billion for mental illness and addiction treatment and maternity care.
He said he also pushed to eliminate a proposed tax on employer-sponsored health care. “Originally the plan was to tax the top 10 percent,” he said. “And I thought that would hurt everybody. Instead of employers competing to have the best plan, they would be competing to not be in the top 10 percent.”
Still, the AHCA raised concerns among health care advocates and residents in New Jersey. The state’s members of Congress said they were besieged with calls and emails, and a town hall with Rep. Leonard Lance drew a standing-room-only crowd packed with opponents of the legislation. A liberal think tank in Trenton, New Jersey Policy Perspective, found that MacArthur’s district would have been among the hardest-hit in terms of losing health care coverage.
“There are definitely still serious threats despite the collapse of the AHCA,” said Jon Whiten, vice president of NJPP. He said the group and other advocates would remain on high alert for efforts to repeal Obamacare in one bill or through smaller, piecemeal measures.
After meeting with Pence at the Naval Observatory on Wednesday night, MacArthur and other House Republicans on Thursday announced another amendment that would create a federal “high-risk pool” for those facing serious illnesses. Under that proposal, the federal government would be responsible for 90 percent of a seriously ill consumer’s premium. The amendment calls for an extra $15 billion for this “patient stability fund,” on top of $100 billion that had already been designated.
“It allows people who have the most claims to buy insurance like everyone else,” he said. “Unlike Medicaid where people are stuck in a program, and have to find a doctor that might take it…nobody would view [high-risk pool consumers] any different from any other insured.”
Members of the Freedom Caucus have been pushing for separate proposals to allow states to apply for waivers of certain requirements under Obamacare. MacArthur declined to say he would support such an idea but left the door open.
“This stuff comes down to specific language and there are some things you can’t make a decision on based on a concept,” he said. “This is the big question. Where do state powers end and federal powers begin? There’s nothing magical about the federal government that makes what comes out of Washington better than what comes out of the states. Quite the opposite.”
Dealing with disparate factions on complex insurance issues has been part of MacArthur’s life since he was a claims adjuster in New York City in the 1980s, he said. He then acquired and expanded an insurance company of his own, and ended up financing his run for the congressional seat in the 3rd District largely by himself, with $5 million.
The defeat of the AHCA offers several lessons for Republicans, said MacArthur, who is in his second term. Major legislation should come from bipartisan negotiations—that way, you avoid the possibility that it will be scrapped and rewritten when the balance of power shifts in Washington, he said.
“We are in a sense moving from an opposition party to a governing party,” MacArthur said, echoing Ryan. Under President Barack Obama, “it was very easy for some people to just be no on some things because they didn’t like the president, and we’re not in that situation today,” he said.
“I think bragging about inaction is really unacceptable,” MacArthur said.
The experience of losing a special-needs daughter, Gracie, to medical complications when she was age 11 also made an impact on MacArthur’s views on health care.
“In the 11 years of her life she had over $1 million in health care bills,” he said. “If I didn’t have insurance I would have been bankrupt, and I take that perspective with me every day when I go to the negotiating table.”
While MacArthur was negotiating changes to the AHCA, other New Jersey Republicans were seen as having a pivotal role in its defeat. Rep. Rodney Frelinghuysen, chairman of the powerful Appropriations Committee, set off death knells for the bill last month when he announced he was a no, arguing “it would place significant new costs and barriers to care on my constituents in New Jersey.“
In a Facebook statement last month, Frelinghuysen said “in addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues.”
The White House was busy trying to land a new health care deal this week, but the House just entered a two-week recess without one.
