Despite grand promises about amazing healthcare for all emanating from President Trump, the devil has, indeed, been in the details as the GOP has efforted to repeal and replace Obamacare. That’s why we’re here — lumbering toward the end of Trump’s first 100 days in office without the prime legislative accomplishment that he wanted (and probably needed) to anchor his claims that his honeymoon phase has been victorious.
In the first go-round, the Paul Ryan-led plan got pulled just prior to a vote in the House because the more conservative members of the GOP caucus wouldn’t support a plan that left key Obamacare provisions like subsidies (or, in this case, tax credits) and guaranteed Essential Benefits in place. But while the supposed death of Trump’s interest in continuing to try and reshape healthcare didn’t prove true, and while his olive branch to Democrats seemed more like a wooden dagger, it seems that the newest plan looks a lot like the old one … with a few key tweaks that seem like they’re targeted at flipping conservatives.
We should state, of course, that none of this is confirmed, but according to HuffPo, the new bill will:
Allow states to get waivers eliminating the so-called community rating provision ― the rule that prohibits insurers from charging higher premiums to people with pre-existing conditions. In order to obtain the waiver, states would have to participate in a federal high-risk pool or establish their own, and satisfy some other conditions.
In exchange for that conservative concession, the amendment would reinstate the Essential Health Benefits that were already taken out of the bill ― though, again, states could waive those provisions as well if they were able to show that doing so would lower premiums, increase the number of people insured, or “advance another benefit to the public interest in the state.”
Let’s assume that many deep red (or Republican-controlled) states will apply for these waivers since it has been those states that resisted the expansion of Medicaid that was made available through Obamacare. This could be a pretty significant chunk of the population that could be exposed to big premium increases or left to the hazards of relying on federal and state high-risk pools (that are often underfunded and sometimes limit enrollment, come with waiting lists, and impose lifetime caps) to offset those sky high costs. How sky high?
According to a study by the liberal-minded Center for American Progress , it could all depend on which disease you’re afflicted with and how severely insurance companies want to punish you for it.
That’s a breakout from the report which posits that, if freed to charge people more if they have pre-existing conditions (while, at the same time, being bound to still offer them coverage), insurers might tack on that middle number (surcharge in dollars) to cover the high cost of covering those patients. And if that happens, why bother having insurance?
On the business side, it’s easy to understand why the insurance companies might want to pawn off the cost of covering sick people on those sick people. And some will say that, if they do that instead of spreading those costs among everyone with insurance, these companies will be able to lower prices for anyone who isn’t already sick, but would there be any guarantee that insurance companies won’t just pocket those savings?
Keep in mind that this also assumes that there won’t be any limits imposed by states that opt out, which could be a big “if.” No politician is going to want to be tied to something that hands a cancer patient a $140,000 bill for a worthless insurance card. That could also be a massive headache where the high-risk pools are concerned since the government would be partially responsible for covering the cost of coverage. But it still illustrates a key concern that comes from high cost/no impact insurance and the so-called “skinny plans” that could become the norm if the Essential Benefits get stripped: what’s the point of having insurance if you don’t have insurance?
CNN basically asked Health and Human Services Secretary Tom Price that question in a segment on Wednesday night, and his answer was not inspiring. As CNN pointed out, if someone can’t pay their medical bills (whether it’s because they don’t have insurance or because their insurance is garbage), in the long run, those costs don’t get written off, they get spread around to everyone. This results in higher costs across the board and more people struggling to pay their medical costs.