Thread: Republican Health Proposal Would Undermine Coverage for Pre-existing Conditions

Republican Health Proposal Would Undermine Coverage for Pre-existing Conditions

Margot Sanger-Katz
APRIL 4, 2017

Throughout the debate to repeal and replace the Affordable Care Act, President Trump and Republican congressional leaders have insisted they would retain a crucial, popular part of the health law: the promise that people can buy insurance even if they’ve had illnesses in the past.

Their efforts foundered last month, when a House health bill had to be pulled from the floor after it failed to attract enough support. Late Monday night, word emerged that the White House and the group of conservative lawmakers known as the Freedom Caucus had discussed a proposal to revive the bill. But the proposed changes would effectively cast the Affordable Care Act’s pre-existing conditions provision aside.

The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

The proposal is not final, but Mr. Meadows told reporters after the meeting that his members would be interested in such a bill. To pass the House, any bill would need to find favor not just with the Freedom Caucus, but also with more moderate Republicans. It would also need to attract the support of nearly every Republican in the Senate to become law.

The ability to opt out of the benefit requirements could substantially reduce the value of insurance on the market. A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs.

The second opt-out would make the insurance options for those with pre-existing conditions even more meaningless.

Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted. If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.

There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care — or even any cancer patients — would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.

We do not have to speculate to know what the world looks like without essential health benefits and community rating. It was how most state insurance markets worked before Obamacare. Back in 2009, most sick people who did not get insurance through work or a government program were excluded from coverage if they had a history of health problems like allergies or arthritis. Plans that did not cover pregnancy care or drug addiction treatment were widespread. (The data about individual market insurance premiums is a little spotty, but it appears that they were substantially lower in most states.)

One idea Republicans have about how to care for the sick was also in effect pre-Obamacare. Many states had “high-risk pools,” where people shut out of the traditional insurance markets could buy special plans with the help of state subsidies. The Freedom Caucus proposal is likely to include some money that states could use to set up such pools.

“The fundamental idea is that marginally sick people would pay with risk associated with their coverage,” Mr. Meadows said Monday. “Those that have, you know, premiums that would be driven up because of catastrophic illness or long-term illnesses, we’ve been dealing with that for a long time with high-risk pools.”

But insurance in the old high-risk pools tended to be expensive, and often came with long waiting periods or benefit limitations, even for the very sick.

The main difference between the policy environment in 2009 and today is that the federal government would now be offering tax credits to help healthy people buy what would probably be relatively skimpy plans. That would mean that more middle-income Americans would probably have health coverage than before the Affordable Care Act, since the combination of policies would tend to make insurance much more affordable for people who are young and healthy.

What states would choose to do with this set of options is hard to predict. Before Obamacare, few states required community rating of health plans. And few states required insurers to cover all of the benefits deemed essential under Obamacare, though most did require a few types of treatments to be covered. State governments would face a difficult choice: either take away the requirements, and leave sick patients without insurance options, or keep them and see people unable to afford coverage under the new subsidy system.

Under Obamacare, states can already waive many of the law’s insurance rules if they can show that an alternative program would cover as many people with comprehensive coverage at a lower cost to the government. But that standard is difficult to meet. Mr. Meadows suggested that the waivers under discussion should be “very easily granted” to states.

The politics of health care in the United States have shifted since the Affordable Care Act was passed seven years ago. In recent months, the law has grown more popular, and the pre-existing conditions policy is among its best-known protections. That could create political pressure for states to keep the insurance rules, even if they are not required by law. But it is likely that at least some states might decide to eliminate them if they are made optional. Shifting norms about health insurance regulation may also affect the idea’s reception in Congress.

Mr. Meadows said that the proposal presented to the Freedom Caucus would retain the pre-existing conditions policy. But that would be true in only the most literal sense. The mix of policies could allow insurance companies to charge sick people prices that few of them could pay. And it could allow them to exclude benefits that many healthy people need when they get sick. The result could be a world where people with pre-existing conditions would struggle to buy comprehensive health insurance — just like before Obamacare.

https://www.nytimes.com/2017/04/04/u...onditions.html

And the Freedom Caucus thinks this will be more popular and get them rel-elected in 2018? Really? Well, then have at it, pass the damn thing, make sure the mandates on individuals and employers are out of there, and the free market will manage the rest. Trump is going to push to "erase the lines", repeal of the McCarran-Ferguson Act and those interstate policies which will be the best policies will have all standard coverage for treating all hospitalization and drug therapies. Otherwise, why buy insurance to begin with? The big companies know this, so just give the "states" their options, because it won't matter. These new policies will be national policies and your stupid little state tricks to discriminate against sick people or older people won't matter one whit or one little bit.

Cut it loose and let the American People and our good companies rock n roll free of all the shackles, plots and schemes of government stupidity.

Pre-existing coverage is something that needs to be given thought. Obviously, people need treatment no matter the illness.

If insurance is not made mandatory, then what is to keep people from simply not purchasing insurance until they become ill? If they do that, then is it fair others who have paid for coverage for years, have their premiums raised to cover the expenses of those who chose not to be covered for those years?

Insurance is about shared risk,- but it should be a shared risk. In other words, some are made to pay all along and some will be able to jump in and 'share' when they want.

The Little Red Hen Comes to Mind.

Not everyone chooses to purchase the same coverage in healthcare. Some want only a policy that will cover major medical, hospital stays, emergency care and with varied deductibles. Some want a policy that covers everything and anything. Obviously, the premiums will and should vary.

It seems the government might want to take that away from you.

Also, when the federal government starts controlling insurance, that means all the American people will have to deal with Washington to address any problems. Good luck -

If it allows for the states not to be able to regulate prices of insurance, it means everyone is going to be paying the same premium, regardless of 'hospital bed' prices in your state.

So, imagine the price for 'hospital bed' in NYC is $100 a day (just saying), but the 'hospital bed' price in Texas is only $80, how long before the hospitals will be charging everyone the same. In other words, states where it is more economical to live, lower wages, lower 'hospital bed' prices, will now be paying the same as all other states.

It happened with Medicare -

We need to be careful what we wish for - we might just get it.

I have a novel idea - get the illegals out of this country. Stop bringing in immigrants who can't support themselves and who then bring in the entire 'extended' families and refugees - many needing medical care. Put Americans to work and stop the idea that the government is going to solve all your problems. Perhaps then, we could afford coverage.

To me, you have to start with the basics. If people want health insurance, they can buy it. If people don't want it, they shouldn't have to buy it. This country existed a long time and did much better before Obamacare and its mandates on employers and individuals. The mandate is the REASON premiums rise because it's a legislated market, not a free market. Prices always rise when you're forced to buy or provide something by the government. Telling any business, insurance or otherwise, I don't want your over-priced crap is a key ingredient of our free enterprise system. Government mandates have never brought the price of anything down, they've always done the opposite, and they've never expanded service, it's decreased it, unless the government was providing the service directly like Medicare and Medicaid.

So the mandates must go. The artificial state lines resulting in these little pools within a state must go and will be gone with the repeal of McCarran at least for health insurance companies. That new competition on a multi-state and national basis together with removal of the government mandates will increase the size of the pools, reduce the risk with the larger market, and the new national competition without mandates will reduce the price and increase the services. The plans will be much simpler and far better.

And yes we need to get the illegal aliens out of the country, all of them, minor children even if born here included, we need to cut our refugee program to zero and reduce our legal immigration substantially, if not go to a moratorium for 10 to 20 years. Cotton has a bill that will reduce green card admissions by about 50%. Start there and pass that bill and then evaluate it again next year and cut that number in half. The benefits of cutting legal immigration along with stopping illegal immigration will be staggering. The savings will be enormous.

Yes, you should be able to buy insurance if you want it - or not buy if you don't. Mandates are not right - but without them, once again, those who will be responsible will be paying for those who refuse to be.

But - being as insurance is a shared risk - and it is - all policyholders have a vested interest in the way it is operated. Their premiums/coverage is affected by this.

So, once again, one person carries health insurance all their lives, paying into the shared risk pool. Some people use it a lot some don't. So, the 'risk' comes in when you think if I don't have it, I 'risk' needing it and going broke. The other 'risk' is, if I pay all those years and don't need it, I'd have been better off putting it in an investment. That's why it is a 'risk'.

Now, the person who refuses to pay the premiums all those years, AND does not save for his own medical needs, reaches his mid 50's and is diagnosed with serious cancer, and is allowed to purchase insurance with a company. Should all the other people have their premiums raised, because this person 'gambled' he wouldn't get sick and didn't buy insurance or save?

I don't think so - I'm not sure what the answer is - but I don't think other responsible people should have to pay for those who were unwilling to be responsible. That's the problem in our country today.

The idea that insurance companies will either be only regulated by the federal government or not regulated at all just seems like a really good formula for disaster. There really are only a few health insurance companies - of any note. Now with no one, other than distant Washington congresscritters, overseeing them, what could they do. We will all be paying the same premiums across the nation regardless of the cost in our area. Now, of course, that cost won't stay different for long. Just long enough for the healthcare providers to realize they can charge more. So goes the upward spiral of costs, or the downward spiral of benefits.

The federal government has never gotten involved with private enterprise that it didn't end up being a disaster for the American people. This will, also, I fear.

This is a like having no insurance on your home, but when it catches fire, you run to the agent and demand to be able to purchase fire insurance. Is that fair to the other homeowners who have paid 20 years?

Sounds like health insurance you can't afford to get sick with - they only want to insure those that don't need health insurance presently. Here, take my money as long as I'm well, then throw me off or charge $$$$$ for health treatment if I become ill or need testing. Are they for real! They are sick in the head and soul.

nntrixie wrote (excerpt):

Now, the person who refuses to pay the premiums all those years, AND does not save for his own medical needs, reaches his mid 50's and is diagnosed with serious cancer, and is allowed to purchase insurance with a company. Should all the other people have their premiums raised, because this person 'gambled' he wouldn't get sick and didn't buy insurance or save?

I don't think so - I'm not sure what the answer is - but I don't think other responsible people should have to pay for those who were unwilling to be responsible. That's the problem in our country today.

You're absolutely right.

Yes, you should be able to buy insurance if you want it - or not buy if you don't. Mandates are not right - but without them, once again, those who will be responsible will be paying for those who refuse to be.

If you study the course of health insurance and the cost of medical care, the cost of medical care rose in parallel with the cost of health insurance. So you could argue that all the responsible people who purchased health insurance made medical care unaffordable for everyone else. They did the same thing to auto insurance with mandatory auto insurance. The same thing is happening with dental care because of dental insurance. When you think about it, they're all Ponzi Schemes that feed a beast and eventually the beast eats you.

It's what can happen when you don't have adequate competition and choice to control costs in an otherwise free enterprise economy. It's why we have the Sherman Anti-Trust Act (1890) and Clayton Act (1914). It's also why the insurance industry wanted to be exempt from them and has been since 1945. It's time to repeal the entire McCarran-Ferguson Act of 1945, starting with health insurance companies, which the US House of Representative has done with health insurance companies voting 416 to 7 to repeal and hopefully the US Senate will pass HR 372 as well and move our country back on track in the right direction.

This repeal of McCarran, was introduced by Paul Gosar, and god bless him for doing so quickly and many thanks to all the members of the US House of Representatives who voted for it.

As to the responsible versus irresponsible who purchase or don't purchase health insurance, I don't really see it that way. I don't think of people who are uninsured as irresponsible people. I know people who have insurance and people who don't, there's no moral or sanctity advantage of the insured over the uninsured. There really isn't. If you ever needed someone to help you or have your back, 9 times out of 10, it will be one of the uninsured that will be there with the shirt off their back to help.

These judgments of responsible versus irresponsible aren't the issue. The issue is predominantly a "charity" based medical industry that thrives off of a private health insurance industry that has inexplicably been exempt from the Sherman Anti-Trust and Clayton Acts for 72 years, the only business in our country to be so. It's no wonder then that for the past 30 years, there's been a problem with this industry, is there? The real question is why has it taken 30 years to fix it?

The reason is most Americans didn't know anything about it. I learned about it around 10 years ago investigating something on mandatory auto insurance and stumbled across a press release from an association of auto repair shops. They had joined together to repeal the McCarran-Ferguson Act because of how it impacted consumers in their industry. As I researched the bill they were talking about and realized McCarran-Ferguson applied to ALL INSURANCE, I was truly aghast. I couldn't believe that 1/5 of the US economy was exempt from the Sherman Anti-Trust Act, if regulated by a state insurance commissioner.

The people of our country didn't know. Many still don't know and many of those who do know don't understand the significant harm this exemption has caused them and will until it is fully repealed.

Spread the word!! Fixing 1/5 of the US economy is easy peasy, it starts with the full repeal of the McCarran-Ferguson Act of 1945 whose sole goal was to ALLOW insurance industry collusion, anti-competitive behavior, price-fixing, and unfair and fraudulent trade practices that violate the Sherman Anti-Trust Act as amended in 1914 with the Clayton Act by Teddy Roosevelt and the Republicans. It's time for Republicans to actually stand up for what our party stands for, don't you think?

Do that and the rest will pretty much fall into place.

Maybe I don't call them irresponsible for not having insurance - but I do call them that for thinking others who have been paying for years, should suddenly pick up the tab for them who have chosen to put their money elsewhere, and not make provisions for themselves and their families.

No, I don't think health insurance made healthcare unaffordable for everyone. Things got really silly after Hillarycare didn't pass and our congress quietly put in place many mandates for insurance companies that Hillary wanted. That had a huge impact on the industry and many small companies went out business.

Actually, insurance companies held the cost down by making their coverage and their premium be based on the area/state norms for costs. They also did not let doctors gouge patients as they now do.

After than a person had less power to make his own decisions about his insurance. If someone wants a policy that does not include plastic surgery, drug addiction, mental health, they should be able to do so. If someone is unable to have a child, due to age or health reasons, why should they have to pay for maternity for others?

With the government running it, it will be a debacle. Look what the feds did for our education system, and we think they know best how to control our healthcare - whether we receive treatment/what treatment?

There is also the possibility insurance companies will just give up the healthcare business. Many have already. Will the government then just take it over? I don't know.

BUT, one thing I wish we would all consider - The government - meaning our esteemed congresscritters, bureaucrats, etc., are in charge of our healthcare and are going to decide what we pay, what can be covered, etc.

Are they including themselves and their healthcare in this? Will they now have to pay their own premiums when they leave office - or if over 65 - go on Medicare. Will all those government employees with their great insurance plans - paid for by taxpayers - have to participate in the same plan they make for us?

That will be the test of whether this is a good idea or not - It is a GOOD plan only if they are willing to participate.

One thing also, it is going to be much easier for any lobbyist to pay off the few in Washington, all gathered together with one mindset, (lining their pockets) than it has been to control the lawmakers and state houses of 50 different states. It has just been made a thousand times easier for them to get what they want.

Let's see.