Latest Republican health care tactic: A sneak attack on people with pre-existing conditions

In the fine print, GOP bill guts coverage of “essential health care benefits,” with devastating consequences

It’s becoming clear that Senate Majority Leader Mitch McConnell’s plan to decimate the American health care system is to tinker around the edges of his bill until, as Charles Pierce of Esquire argued, “you get a CBO score you can plausibly use to con the country, the elite political press, and the mind of Susan Collins into thinking you’re ‘moderating’ the bill.” McConnell is counting on the fact that the press is easily bored and always eager to move onto the next new thing — often meaning whatever President Trump has just said on Twitter — and all he needs is a week of such distractions to pass this stinker under the cover of darkness.

But don’t let the tinkering or assurances that the health care bill is somehow becoming more moderate fool you. Republicans still plan on passing a bill that will lay waste to the protections offered ordinary Americans in the Affordable Care Act, leaving people vulnerable to financial ruin or even death from illnesses or conditions that are covered under existing law.

One of the ways Republicans plan to do this is to gut the part of the Affordable Care Act that guarantees coverage of what are deemed “essential health care benefits.” That sounds like a minor bureaucratic adjustment, but in reality it’s a back-door way to deny coverage to people with pre-existing conditions, limit important and life-saving health services, and force people with expensive conditions to go bankrupt rather than rely on insurance to cover them.

The essential benefits that the Affordable Care Act delineated include 10 categories of care that every insurance plan has to cover. Some of these categories are straightforward things that most insurance plans, whether purchased on the individual market or provided by employers, already covered, such as hospitalization or doctor’s visits. But, as Timothy Jost, a professor at the Washington and Lee University School of Law and an expert on health care law, explained in an interview, prior to the passage of the Affordable Care Act many individually purchased plans skipped major categories of coverage.

“What they didn’t cover was maternity care, mental health and substance use disorder care — and often prescription drug coverage was quite limited,” Jost said. “The ACA also added habilitation care for special needs children.”

Under various versions of the Republican plan, states would be able to apply for waivers to exempt plans sold in their state from this mandated list of essential health care benefits. Republicans have repeatedly insisted that their bill bars discrimination against patients with pre-existing conditions. But as Jost explained, ending essential health care benefits creates a mechanism that allows insurance companies to deny coverage of those pre-existing conditions. You’d be allowed to buy insurance, but it might not pay for the things you really need it for.

“So you got a mental health problem, sorry, we’re happy to insure you, but we don’t cover mental health problems,” Jost said, describing the logic. “You’ve got cancer? We’re happy to insure you. We don’t cover any chemotherapy drugs or we don’t cover radiation therapy.”

Presumably, the reason Republicans want to cut essential health benefits is to lower premiums — which is why we get to hear Republican politicians making cracks about how men don’t need maternity care — but Jost said he believes the mandatory benefits “are really a very small part of the total cost of coverage.”

For instance, as Jost has argued on the Health Affairs blog, ending mandatory maternity coverage “might lower premiums by $8 to $14 per month,” but would force women who are giving birth to pay as much as $30,000 to $50,000 in out-of-pocket expenses.

Most of these effects would be felt by people who buy insurance on the individual market, or who work for small companies employers that offer less expensive plans with skimpier coverage. As Matthew Fiedler, a fellow with the Center for Health Policy in the Brookings Institution’s Economic Studies Program, explained, there’s a poison pill buried in the bill that would also affect people who work for large employers that offer more generous health insurance packages. Repealing mandatory essential health care benefits would mean reintroducing lifetime limits or annual coverage caps for many people on those plans. Which means that a lot of people who thought they had generous, comprehensive insurance plans could still face bankruptcy in the event of a serious illness or accident.

Under the ACA, Fiedler explained, “Insurers can’t put lifetime or annual limits on types of care that are considered essential health benefits. But they can put lifetime or annual limits on things that aren’t essential health benefits. What that means is that when the definition of essential health benefits changes, that can substantially change the scope of the protection against annual or lifetime limits.”

Even if you live in a state that sticks with the old Affordable Care Act definition of essential health benefits, you may not be protected if you work for a large employer, defined as any company or entity with 50 or more employees. That’s because, according to Fielder, a large employer can choose any state’s definition of “essential health benefits.” It doesn’t have to stick to the state where it does most of its business, or where its employees actually live.

“Employers could choose a state that had implemented a very lax definition of essential health benefits and thereby have fairly broad latitude to impose these kinds of limits,” he explained.

So a worker in a state like California or Massachusetts, which is likely to continue to protect essential health care benefits, might find that her employer has instead chosen define essential health care benefits under the terms set by Texas or Mississippi. So while that person’s policy might still cover cancer treatments or maternity care or mental health services, she might find out that in practice her insurance company will not cover nearly as much of the cost as it would have under the ACA.

Because of the ban on lifetime and annual limits, the cap on out-of-pocket spending for patients, and the ban on discrimination based on pre-existing conditions, the Affordable Care Act was able to cut the number of personal bankruptcy filings in the United States by half between 2010 and 2016. By drafting a way for states to opt out of the essential health care benefits mandate, the Republican bill will potentially allow insurance companies to dump those costs back onto the consumer. The number of medical-related bankruptcies could well soar back to pre-Obama levels — if Mitch McConnell can find a moment when we stop paying attention and ram this bill through the Senate.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

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The face of Republican evil: It’s not Donald Trump

Mitch McConnell’s gruesome health care scam reveals the corrupt, antidemocratic character of the entire GOP

In the hellish months since Donald Trump’s inauguration, a dark parlor game of sorts has cropped up in liberal circles that I like to call “Would an Impeachment Even Be Worth It?” With the full acknowledgment that it’s unlikely to happen as long as Republicans are in charge, participants still sip cocktails and ponder out loud the question of whether booting out Trump on his butt would be enough to save our democracy, considering the fact that the Republican slimeball taking his place would invariably sign a bunch of retrograde legislation setting back this country decades.

These discussions break down into two camps: those who think Trump presents a unique threat to our democracy and replacing him with someone in the succession line, like Vice President Mike Pence or House Speaker Paul Ryan, would at least preserve our democratic norms; and those who think the corruption started long before Trump and has spread throughout the Republican Party, rotting it from the inside out.

Consider me in the latter camp, which makes me kind of unpopular in these discussions. Unfortunately, my view that the Republican Party as a whole is irredeemably antidemocratic has been borne out, yet again, in the process that Senate Majority Leader Mitch McConnell has put into motion to destroy the Affordable Health Act, a process that will likely take out the U.S. health care system as we know it.

One could even argue that bog-standard Republicans, under the leadership of Ryan and McConnell, represent an bigger threat to our democracy than Trump, possessing as they do more competence and cunning than the TV-addled overgrown toddler in the White House.

As Heather Digby Parton, writing for Salon, recently detailed, McConnell has arranged to have the Senate version of the House’s American Health Care Act (which the Congressional Budget Office estimates would ultimately leave 23 million Americans uninsured) written in secret, with no hearings, no public discussion and no real debate. Republicans are barely even pretending the reason is anything other than the obvious: The bill is so terrible that it defies the will of people of all political stripes and sensibilities, whom legislators supposedly were elected to serve. When called out on this obvious fact, Republicans are just smirking or squawking “fake news” but not actually offering any contravening evidence.

McConnell’s contempt for the processes, much less the defining principles, of democracy couldn’t be more apparent. But he doesn’t really care. No doubt the election of Trump helped confirm the rising sense among Republicans that they can wipe their collective butts with the Constitution, flip the bird at their constituents and not really worry about losing many seats. Republican voters might not like it, but they like liberals, black people and feminists even less, so they will show up and dutifully vote against the Democrats every time. Losing health care access isn’t great, but for conservative voters, admitting that liberals might have a point is a hell from which there is no escape.

This Republican contempt for democracy was evident long before Trump started grasping for the presidential nomination with his stubby orange fingers. McConnell was so unwilling to accept the legitimacy of Barack Obama’s two substantial presidential election victories that the Republican leader refused to acknowledge Obama’s right to nominate a Supreme Court justice after Antonin Scalia’s death. Not only did that work out perfectly for McConnell — he got Neil Gorsuch onto the high court, instead of rightful nominee Merrick Garland — but it proved once and for all that bedrock conservative voters don’t care about niceties like the rule of law or government by the people. They just want to punish women for having sex and gripe about “Obama phones,” and don’t care if the price paid is the ultimate ruin of this country.

Trump didn’t make Republicans corrupt. They were already there. That’s why he hasn’t really needed to do any arm-twisting or commit blackmail, no matter how much he’d like to, in order to get a GOP-controlled Congress willing to look the other way when presented with a growing pile of evidence that something weird is going on with Trump and the Russians.

It’s easier to not care if Russian intelligence is actively seeking to subvert U.S. elections for those who aggressively try to deny voting rights to millions of Americans, especially people of color and younger voters who insist on voting for Democrats.

At this point, the Republican rejection of democracy is an established fact. The only question is how far the ruling party is willing to take it. The antidemocratic, secretive process surrounding the GOP’s health care bill suggests there may be no real limit.

 

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

Paul Krugman: Under Trumpcare, millions will lose coverage, many will die

 — and the GOP will try to blame it on liberals

A moral disaster is under way

Paul Krugman: Under Trumpcare, millions will lose coverage, many will die — and the GOP will try to blame it on liberals
(Credit: Getty/Mark Wilson)

AlterNet

“Every word,” Paul Krugman writes in Monday’s column, of the disastrous American Healthcare Act, “is a lie, including ‘a,’ ‘and’ and ‘the’.”

Sure, politicians aren’t exactly revered for their truth-telling abilities, and Congress has passed cruel and unjust laws, even lied about exactly how cruel and unjust, but rarely has there been a law like Trumpcare, which Krugman calls “a miserably designed law, full of unintended consequences… a moral disaster, snatching health care from tens of millions mainly to give the very wealthy a near-trillion-dollar tax cut.”

Instead of spending the last seven years coming up with a credible replacement for Obamacare, Republicans used that time to craft a series of lies. They claimed Obamacare was rushed through without debate (there were multiple committee hearings, markups and a CBO score, all of which the AHCA was missing). They claimed “Deductibles were too high…so were premiums. They promised to bring these costs down, to provide, as Donald Trump insisted he would, coverage that was ‘much less expensive and much better.’”

They also promised to keep the parts of the law everyone liked (conveniently without admitting that these provisions were due to Obamacare in the first place): no one would lose Medicaid or be denied coverage for pre-existing conditions.

In a feat of doublespeak not even Orwell could have seen coming, Krugman reveals the opposite of all of those points is true:

Deductibles will rise, not fall, as insurers are set free to offer lower-quality coverage. Premiums may fall for a handful of young, healthy, affluent people, but will rise and in many cases soar for those who are older (because age spreads will rise), sicker (because protection against discrimination based on medical history will be taken away), and poorer (because subsidies will go down).

And about those pre-existing conditions? Let’s hope you’ve never had so much as a cold, because for many Americans, coverage will either be unavailable entirely or so prohibitively expensive, it might as well not exist. Despite Trump’s frequent campaign promises, Medicaid too will be cut. But who cares about the working poor when there are tax cuts for the rich to be had?

After all, as Krugman reminds us, “according to independent estimates of an earlier version of Trumpcare — people with incomes over $1 million would save an average of more than $50,000 a year.” We must never lose sight of the fact that “there is a powerful faction within the G.O.P. for whom cutting taxes on the rich is more or less the only thing that matters.”

Perhaps the worst part of this whole charade is that the people who trusted Trump the most, the white working class that the mainstream media fetishizes, are the ones who stand to lose the most. And when it goes wrong, when the base loses its benefits and people can’t go to the doctor and are in danger of dying, the GOP will find a way to blame it on liberals.

Krugman leaves us with a warning, one that those who think this will be an easy win for 2018 would do well to heed: “What just happened on health care shouldn’t be treated as just another case of cynical political deal making. This was a Freedom is Slavery, Ignorance is Strength moment. And it may be the shape of things to come.”

 

 

http://www.salon.com/2017/05/08/paul-krugman-under-trumpcare-millions-will-lose-coverage-many-will-die-and-the-gop-will-try-to-blame-it-on-liberals_partner/?source=newsletter

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die

With the AHCA, the Republicans have put a price tag on the lives of America’s working class: $300 billion

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die
(Credit: AP/Susan Walsh)

Trumpcare, Ryancare, Trashcare — whatever you want to call it, the American Health Care Act is nothing more than a cheap stab at Barack Obama, a petty attempt on the part of grudge-holding Republicans, including President Donald Trump, to try to diminish Obama’s legacy. They can try, but that will be impossible — Trump’s follow-up act has been so bad so far that he’s making George W. Bush look practically Lincoln-esque. But let’s set legacies and agendas aside for now and focus on health care.

“We have come up with a solution that’s really, really, I think, very good,” Donald Trump has said. “It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

I’m not a president or a billionaire. I could never afford the kind of routine checkups that Trump has access to from award-winning physicians with platinum stethoscopes and solid gold scalpels — or even a state-of-the-art Viking fridge stocked with spare teenage hearts and kidneys, all plump and ready to be inserted when Trump’s conk out. He’ll probably live to be 360 years old as a result. Most of us don’t have that experience, and the president, just like the congresspeople and senators who are aimlessly playing with the lives of their constituents by threatening to kill Obamacare, is taken care of. They have amazing health care coverage that we, the taxpayers, fund. Strangely, that never makes it into the conversation.

Is Obamacare perfect? Absolutely not. But it has already saved the lives of millions of people. People who would have never voted for Obama are calling him a hero, even as some die-hard right-wingers praise the Affordable Care Act for saving their loved ones, not realizing that it’s the same as Obamacare.

Trump loves his catchphrase, “Make America great again.” Obviously he doesn’t understand that “great” is a process that we must constantly work toward. Greatness is edited, nurtured and achieved after recognizing what works and what doesn’t. Scrapping Obamacare and replacing it with a trash plan that will leave millions of people who were born without the luxury of being Trump-level rich uninsured is not making anything great. It’s evil. According to the CBO analysis, the AHCA would “reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.” And every Republican is running to the cable news networks, bragging about saving $300 billion. What does that mean to the person the Wall Street Journal described, a 62-year-old person who makes $18,000 a year who will now face premiums of up to $20,000?

Imagine a sickly elderly woman running home from work to her family to share with pride that the government just saved $300 billion. There is nothing more important than that to the government, even if it means that you’re broke, your granddaughter is pregnant because she couldn’t get birth control, and your grandson overdosed and died because he couldn’t be treated for his prescription drug addiction, which he developed to self-medicate his depression over the factory jobs that Trump promised never coming. We should all celebrate because the government saved $300 billion? That’s $300 billion that regular people will never touch.

People will not be treated for their illnesses. Many will suffer, and some will die. But at least the GOP beat Obama!

D. Watkins is an Editor at Large for Salon. He is also a professor at the University of Baltimore and founder of the BMORE Writers Project. Watkins is the author of the New York Times best-sellers “The Beast Side: Living  (and Dying) While Black in America” and “The Cook Up: A Crack Rock Memoir.”