AHCA – Trump Care – Pre X?
Personally I resent all the news articles and especially all the Facebook posts that say things about the technical legal aspects of law, without citing the actual law. Even when one has the actual law, you still need to read it three times and then when you thing you understand it, read it again. I guess especially egregious is Congress passing ACA and now AHCA without time to read the law first. Below, I will attempt to find the citations mentioned in various news articles and then we can sort fact from fiction.
If you take a quick read into American Health Care Act, it would appear as though the provision on pre-existing conditions has remained untouched. But when you take a closer look, the AHCA requires “continuous coverage” §133 for patients with pre-existing conditions and those with perfect health, meaning that if a patient goes 63 days continuously without coverage, they must pay a 30 percent premium penalty.
“SEC. 2710A. ENCOURAGING CONTINUOUS HEALTH INSURANCE COVERAGE.
“(1)… a health insurance issuer offering health insurance coverage in the individual or small group market shall, … increase the monthly premium rate …
“(2) 30 percent
“(1) ‘applicable policyholder’ means,
“(B) cannot demonstrate ….there was not a period of at least 63 continuous days during which the individual did not have creditable coverage
If you have a pre-existing condition and no gap in coverage, great! You’re just groovy. But, here’s the big problem with “continuous coverage” requirements for pre-existing conditions: If you lose your job or lose coverage because of missed premium payments, your rate will be increased 30 percent if you want a health insurer to take you on if you have a pre-existing condition. Anyone? To put it plainly: The continuous coverage stipulation is not the same as requiring health insurance companies to cover individuals with pre-existing conditions, as the Affordable Care Act did. Instead, those with pre-existing conditions who are struggling financially will, in many cases, be charged more for their insurance. So, will everyone else. Romper.com 3.7.2017
As we described yesterday, there are some concerning policy elements of the House-passed American Health Care Act, which the Senate would be wise to explore and rectify over the coming weeks. The bill — and that’s all it is at this point: a work in progress — repeals and alters significant portions of the Democratic Party’s failing experiment in “affordability.” But based on rhetoric from elected Democrats and the Left generally, one might assume that Obamacare was called the “Pre-existing Conditions Coverage Act” (side-stepping the whole “choice and affordability” fairy tale they peddled), and that the Republican bill obliterates those protections. The proposed law would be a “death warrant” for sick women and children, they shriek, casting Obamacare opponents as the moral equivalent of accessories to murder. This is demagogic, hyperbolic, inaccurate nonsense. To review the actual facts, even under an exceedingly unlikely scenario in which the Senate passed the House bill without making a single alteration, people with pre-existing conditions are offered several layers of protection:
Layer One: Insurers are required to sell plans to all comers, including those with pre-existing conditions. This is known as “guaranteed issue,” and it’s mandated in the AHCA. No exceptions, no waivers. I spoke with an informed conservative news consumer earlier who was stunned to learn that this was the case, having been subjected to 24 hours of unhinged rhetoric from the Left.
Layer Two: Anyone with a pre-existing condition and who lives in a state that does not seek an optional waiver from the AHCA’s (and Obamacare’s) “community rating” regulation cannot be charged more than other people for a new plan when they seek to purchase one — which, as established above, insurers are also required to sell them.
Layer Three: Anyone who is insured and remains continuously insured cannot be dropped from their plan due to a pre-existing condition, and cannot be charged more after developing one. So if you’ve been covered, then you change jobs or want to switch plans, carriers must sell you the plan of your choice at the same price point as everyone else. Regardless of your health status. This is true of people in non-waiver and waiver states alike.
Layer Four: If you are uninsured and have a pre-existing condition and live in a state that pursued (and obtained after jumping through hoops) a “community rating” waiver, your state is required to give you access to a “high risk pool” fund to help you pay for higher premiums. The AHCA earmarks nearly $130 billion for these sorts of patient stability funds over ten years.
It is simply a lie to say that the AHCA guts protections for people with pre-existing conditions. One can argue that perhaps $130 billion (not $8 billion, as some are dishonestly pretending) might at some point prove insufficient to covering the people described in layer four, but I think any such assessment is at best hypothetical and premature. Either way, it’s a very different critique than the scare-mongering going around right now. Also, I’ll repeat: The number of “uninsurable” Americans with pre-existing conditions within the individual market represents a tiny sliver of the overall population. Helping these people was one of the few credibly-popular selling points and actual achievements of Obamacare. But the existing law’s track record on this front helps illustrate how limited the scope of that particular problem is:
Obamacare created a “bridge” program that allowed previously-uninsurable consumers with pre-existing conditions to get coverage in between the law’s 2010 passage and full implementation a few years later. At its peak, it attracted less than 115,000 takers. Those people matter, and they were helped. But that statistic helps contextualize the problem, especially compared to Obamacare’s overriding flaw: Unaffordability, leading to lack of participation, leading to unsustainable risk pools, leading to insurers pulling out and hiking premiums, leading to unaffordability, leading to further lack of participation, etc. As for the moral bullying about the AHCA supposedly leading to thousands of deaths (with these pronouncements coming from the very same people who lied incessantly and made spectacularly wrong predictions about Obamacare, by the way), consider this data-based evidence:
Public-health data from the Centers for Disease Control confirm what one might expect from a health-care reform that expanded Medicaid coverage for adults: no improvement. In fact, things have gotten worse. Age-adjusted death rates in the U.S. have consistently declined for decades, but in 2015 — unlike in 19 of the previous 20 years — they increased. For the first time since 1993, life expectancy fell. Had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000–13 period, 80,000 fewer Americans would have died in 2015 alone. Of course, correlation between ACA implementation and increased mortality does not prove causation. Researchers hypothesize that increases in obesity, diabetes, and substance abuse may be responsible. But thanks to the roughly half of states that refused the ACA’s Medicaid expansion, a good control group exists. Surely the states that expanded Medicaid should at least perform better in this environment of rising mortality? Nope. Mortality in 2015 rose more than 50 percent faster in the 26 states (and Washington, D.C.) that expanded Medicaid during 2014 than in the 24 states that did not.
If conservatives wanted to turn liberals’ demagoguery against them, they could cite these numbers to claim that Obamacare is killing tens of thousands of people — especially in Medicaid expansion states — and that Democrats have blood on their hands. Murderers! Let’s not match their repugnant hackery. But we should make them aware of evidence that could build that deeply uncharitable and specious narrative. And speaking of Medicaid, I’ve seen a lot of hyperventilating about “deep cuts” to the program, which was already suffering poor health outcomes and restricted access before Obamacare’s huge expansion of it. The AHCA does eventually transition to a major reform of the dysfunctional program, but it does so via a gradual tapering and eventual halt of Medicaid’s expansion several years from now, with existing recipients (including new additions under the continued expansion) grandfathered in. May I repeat: There are flaws in the bill that need to be addressed. But the fact-challenged, emotional, manipulate meltdown on the Left is designed to scare people, not inform them. And it has the side effect of distracting from the spiraling betrayals of Obamacare, a program the Left put in place last time they were in charge. I’ll leave you with this strong editorial from the Wall Street Journal: Town Hall.com