The Washington Post. "Naturally, giving President Trump something to arbitrarily tout as an achievement (even if it passes the House, the Senate looms) in advance of the arbitrary 100-day mark is far more important than the human toll the proposal would have on millions." " />
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Labor News


Sargent: The GOP Has a New Plan to Destroy Obamacare. It’s Even Crueler than the Last One.

04/20/2017

"House Republicans have been hinting they may introduce a new plan to replace Obamacare before the 100th day of the Trump presidency," writes Greg Sargent in The Washington Post. "Naturally, giving President Trump something to arbitrarily tout as an achievement (even if it passes the House, the Senate looms) in advance of the arbitrary 100-day mark is far more important than the human toll the proposal would have on millions.

"Now Republicans are indeed set to introduce the new plan, multiple reports tell us. And judging by a new study set to be released today, it is even crueler than the last GOP plan: The study finds premiums would likely soar for the sick, probably pushing them off coverage.

"The Huffington Post has a detailed rundown of the new GOP plan, which is designed to bridge the gap between moderates and conservatives who rejected the last one for different reasons. It allows states to seek a waiver to get rid of the Affordable Care Act’s prohibition on charging higher premiums to people with preexisting conditions, on the condition that states set up or participate in high-risk pools that would help cover any of those people who lose insurance. It would also restore to the GOP bill the ACA’s requirement that insurers cover Essential Health Benefits (EHBs) — such as doctor’s and emergency room visits and maternity care — but allow states to seek waivers from them.

"In effect, the waiver on preexisting conditions is designed to make conservatives happy, while giving moderates high-risk pools that allow them to argue it wouldn’t harm people with preexisting conditions. The restoration of EHBs is designed to make moderates happy, while telling conservatives states could still get out from under them.

"But the waiver on prohibitions against jacking up premiums for people with preexisting conditions — which is called 'community rating' — is a major problem. It would smack them with far more in costs — potentially pushing them off coverage entirely.

"The liberal Center for American Progress (CAP) conducted a new study — set to be released later today — on how much these premiums might soar for people with various preexisting ailments. The 'surcharge' in the middle column represents additional premium charges that insurers are projected to add to coverage of each condition annually, and the numbers are eye-popping [see the original article].

"Topher Spiro, a health policy analyst at CAP, tells me that these sums were calculated by using actuary 'risk scores' for each condition, which detail how much someone with that condition costs insurers relative to a healthy person. (Focus on the first two columns for now; the third will be elucidated by the report itself.)

“'If insurers can charge sick people higher premiums than healthy people, they would add a surcharge to premiums that reflects this additional cost,' Spiro says. 'The premium markups would be unimaginable, adding thousands or even tens of thousands of dollars to premiums. They would be priced out of the market and quarantined into high-risk pools.'

"Now, in fairness, these findings are based on calculated national averages, so applying them to what would happen in any given state is tricky. But this is intended as a general guideline of what sort of premium hikes we might see in states that did seek waivers — and it’s fair to assume many red states would do so. What’s more, this conclusion dovetails with the general conclusions of other health policy analysts. The big story is that, while the new plan would ostensibly keep the prohibition against refusing to cover people with preexisting conditions, allowing premiums to be jacked up would functionally price a lot of those people out of the market, gutting that protection.

"Indeed, the nonpartisan Kaiser Family Foundation’s Larry Levitt tells me he thinks the CAP projections are plausible. 'These figures show why a guarantee of coverage without community rating offers essentially no protection for people with pre-existing conditions,' Levitt says. 'No insurance company will want to cover people with expensive health conditions if they don’t have to, so they will set premiums to make sure the coverage is out of reach. Health care costs are highly concentrated among a small number of people who are sick, and they would find it impossible to get affordable coverage.'

"Of course, the new plan’s defenders would reply that these people can go into high-risk pools (this is apparently meant to give moderates cover to back it). But they’ve historically been underfunded and/or resulted in people paying higher prices or going without coverage.

"Meanwhile, the new GOP plan would keep in place the old plan’s phase-out of the Medicaid expansion, which would itself result in 14 million fewer people on Medicaid, according to the Congressional Budget Office. You’d think that this, plus the gutting of protections for preexisting conditions, would render the new plan toxic for GOP moderates who, in rejecting the old plan, have confirmed that they are not willing to embrace a massively regressive plan that would push millions of poor and sick people off coverage while delivering an enormous tax cut to the rich. Of course, the need to give Trump a fake achievement to tout is also an urgent matter, so who knows what they’ll do."

Washington Post 4/20

   


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