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Washington — In a major blow to House Republican leaders, GOP Rep. Fred Upton of southwest Michigan said Tuesday he would vote against the health care bill to replace the Affordable Care Act because it doesn’t guarantee protections for people with preexisting illnesses.

Upton, who chaired the House Energy and Commerce Committee until January, told the Michigan radio station WHTC-AM he is not comfortable with revisions that would allow state governors to opt out of some coverage protections.

“I’ve supported the practice of not allowing preexisting conditions to be discriminated against from the very get-go,” said Upton, who is considering a run for U.S. Senate against Democratic Sen. Debbie Stabenow.

“This amendment torpedoes that, and I told leadership that I cannot support this bill with this provision in it. ...It’s not going to get my yes vote the way that it is.”

At least two other Michigan Republicans are undecided on the legislation: Reps. Justin Amash of Cascade Township and Jack Bergman of Watersmeet.

Upton has long worked on health care issues in Congress and voted to advance the initial GOP bill in the Energy and Commerce Committee earlier this year. He later said on the House floor in March he would vote for the early version, shortly before GOP leaders pulled the bill because they didn’t have enough support to pass it.

The bill’s revisions are the result of several weeks of negotiations between a group of more moderate Republicans and the conservative House Freedom Caucus, which strongly objected to the initial legislation.

The amendment, proposed by Rep. Tom MacArthur of New Jersey, would let states opt out of some requirements of the Affordable Care Act, such as the “essential health benefits” provision that requires a minimum set coverage for maternity care, prescriptions and mental health services, among other areas.

The amendment says it should not be construed as allowing insurers to limit coverage for those with preexisting conditions. But health experts say that, by allowing insurers to price premiums based on an individual’s current and past “health status,” the amendment would effectively mean higher and potentially unaffordable costs for sicker patients.

Upton said he met with several Freedom Caucus members on Monday, but they’re “not willing to budge” on the provision regarding preexisting conditions.

“I can tell you there are a number of Republicans that are saying, this isn’t going to fly,” Upton said. “We’ve talked about the protection for preexisting illnesses for the last number of years, and we’re not going to budge either. How it plays out, I don’t know, but there are not the votes, as of this morning, to move this bill forward.”

Since Democrats are opposing the bill as a bloc, House Republicans can afford to lose no more than 22 GOP votes and still pass the health care legislation. An informal count by CNN listed 22 House Republicans intending to vote no and another 16 are undecided as of Tuesday afternoon.

House Speaker Paul Ryan argued Tuesday that the amended legislation protects those with pre-existing conditions.

His office stressed that the amendment keeps intact the Affordable Care Act prohibition on pricing customers based on health status, and that states seeking a waiver would be required to offer a special plan – a high-risk pool or reinsurance program – for individuals unable to secure other healthcare coverage.

Some analysts say concerns about denials over preexisting conditions are overblown, noting that most Americans with insurance fall under employer plans or government programs such as Medicare that must provide coverage regardless of existing medical conditions.

They argue that, before the Affordable Care Act, a relatively small number of Americans were denied coverage over preexisting conditions when they sought coverage on the open market.

But the American Medical Association, which opposes the MacArthur amendment, says individuals with preexisting conditions were “routinely” denied insurance or priced out of affordable plans.

In a letter to House leaders, the AMA says allowing states to waive the prohibition on health status pricing would likely lead to patients losing coverage.

The association also questions whether high-risk pool mechanisms would be “sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions.”

Michigan Democratic Party Chairman Brandon Dillon said Upton’s distancing himself from the GOP bill “shows just how toxic it really is.”

“This is a testament to the power of public pressure,” Dillon said in a statement. “It shows that the people of Michigan are making a difference, making their voices heard, and should continuing fighting back against this disastrous Republican bill so that other members of Congress get the message.”

Amash, a member of the Freedom Caucus, opposed the initial health care plan, saying it didn’t go far enough to repeal Obamacare. Amash is undecided on the new version of the legislation, according to his office.

Rep. Jack Bergman of Watersmeet is also still studying the health care bill. He supported the original overhaul legislation.

Bergman said Tuesday he’s co-sponsoring legislation to remove language from the amended bill seeking to preserve Affordable Care Act coverage protections for members of Congress and their staffs if states were to waive them. The legislation is sponsored by Rep. Martha McSally, R-Arizona.

“We are all equal in the eyes of the law,” Bergman said in a statement. “As members of Congress, we are obligated to live by the standards we set for the American people. In the context of health care, that means coverage should be available to Representatives and our staffs on the same basis that it’s available to our constituents.”

Washington — In a major blow to House Republican leaders, GOP Rep. Fred Upton of southwest Michigan said Tuesday he would vote against the health care bill to replace the Affordable Care Act because it doesn’t guarantee protections for people with preexisting illnesses.

Upton, who chaired the House Energy and Commerce Committee until January, told the Michigan radio station WHTC-AM he is not comfortable with revisions that would allow state governors to opt out of some insurance coverage protections.

“I’ve supported the practice of not allowing preexisting conditions to be discriminated against from the very get-go,” said Upton, who is considering a run for U.S. Senate against Democratic Sen. Debbie Stabenow.

“This amendment torpedoes that, and I told leadership that I cannot support this bill with this provision in it.I don’t know how it will all play out, but I know that there are a good number of us that have raised real red flags, concerns, and ...It’s not going to get my yes vote the way that it is.”

At least two other Michigan Republicans are undecided on the legislation: Reps. Justin Amash of Cascade Township and Jack Bergman of Watersmeet.

Upton has long worked on health care issues in Congress and voted to advance the initial GOP bill in the Energy and Commerce Committee earlier this year. He later said on the House floor in March that he would vote for the early version, shortly before GOP leaders pulled the bill because they didn’t have enough support to pass it.

The bill’s revisions are the result of several weeks of negotiations between a group of more moderate Republicans and the conservative House Freedom Caucus, which strongly objected to the initial legislation.

The amendment, proposed by Rep. Tom MacArthur of New Jersey, would let states opt out of some requirements of the Affordable Care Act, such as the “essential health benefits” provision that requires a minimum set coverage for maternity care, prescriptions and mental health services, among other areas.

The amendment says it should not be construed as allowing insurers to limit coverage for those with preexisting conditions. But health experts say that, by allowing insurers to price premiums based on an individual’s current and past “health status,” the amendment would effectively mean higher and potentially unaffordable costs for sicker patients.

Upton said he met with several Freedom Caucus members on Monday, but they’re “not willing to budge.”

“I can tell you there are a number of Republicans that are saying, this isn’t going to fly,” Upton said. “We’ve talked about the protection for preexisting illnesses for the last number of years, and we’re not going to budge either. How it plays out, I don’t know, but there are not the votes, as of this morning, to move this bill forward.”

Since Democrats are opposing the bill as a bloc, House Republicans can afford to lose no more than 22 GOP votes and still pass the health care legislation. An informal count by CNN listed 22 House Republicans intending to vote no and another 16 are undecided as of Tuesday afternoon.

House Speaker Paul Ryan argued Tuesday that the legislation does protect those with preexisting conditions. His office stressed that states seeking a waiver from the prohibition on pricing customers based on “health status” would be required to offer a special plan – a high-risk pool or reinsurance program – for individuals unable to secure other coverage.

Some analysts say concerns about denials over preexisting conditions are overblown, noting that most Americans with insurance fall under employer plans or government programs such as Medicare that must provide coverage regardless of existing medical conditions.

They argue that, before the Affordable Care Act, a relatively small number of Americans were denied coverage over preexisting conditions when they sought coverage on the open market.

But the American Medical Association, which opposes the MacArthur amendment, says individuals with preexisting conditions were “routinely” denied insurance or priced out of affordable plans.

In a letter to House leaders, the AMA says allowing states to waive the prohibition on health status pricing would likely lead to patients losing coverage.

The association also questions whether high-risk pool mechanisms would be “sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions.”

Michigan Democratic Party Chairman Brandon Dillon said Upton’s distancing himself from the GOP bill “shows just how toxic it really is.”

“This is a testament to the power of public pressure,” Dillon said in a statement. “It shows that the people of Michigan are making a difference, making their voices heard, and should continuing fighting back against this disastrous Republican bill so that other members of Congress get the message.”

Amash, a member of the Freedom Caucus, opposed the initial health care plan, saying it didn’t go far enough to repeal Obamacare. Amash is undecided on the new version of the legislation, according to his office.

Rep. Jack Bergman of Watersmeet is also still studying the health care bill. He supported the original overhaul legislation.

Bergman said Tuesday he’s co-sponsoring legislation to remove language from the amended bill seeking to preserve Affordable Care Act coverage protections for members of Congress and their staffs if states were to waive them. The legislation is sponsored by Rep. Martha McSally, R-Arizona.

“We are all equal in the eyes of the law,” Bergman said in a statement. “As members of Congress, we are obligated to live by the standards we set for the American people. In the context of health care, that means coverage should be available to Representatives and our staffs on the same basis that it’s available to our constituents.Preserving this exemption would undermine our representative form of government”

Rep. Dave Trott, R-Birmingham, also emerged as a co-sponsor Tuesday to this bill without indicating how it might affect his vote on the overall health care overhaul legislation.

“Members of Congress must abide by the laws they create, and, as we work deliberately to improve our nation's healthcare system, we must ensure that all Americans, constituents and Congress alike, have access to the same high-quality care,” Trott said in a statement.

mburke@detroitnews.com

(202) 662-8736

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