Email #189: “mean”?

The American Health Care Act is facing major opposition in the Senate. Republican Senator Burr said: “It’s not a good plan,” and that it was “dead on arrival.” The President reportedly called it “mean” yesterday.

That was true even before the addition of the MacArthur amendment allowed states to waive the essential benefits currently guaranteed under the Affordable Care Act. This is why Republican Senator Collins opposes the bill:

“while I would welcome some changes to improve the flexibility of plans that could be sold, we need to remember that the essential health benefits include substance abuse and mental-health treatment, which are critical to retain for my state given the opioid crisis. Preventative care, vaccinations for children save money in addition to saving lives.”

It’s hard to vilify a law that requires health insurance companies to cover such basic things as pregnancy, hospitalization, and prescriptions drugs, but Speaker Ryan has done his best, calling the ACA’s benefit list “arrogant and paternalistic mandates.” Under the AHCA, states would be free to allow insurance companies to underinsure patients by selling them cheaper, riskier packages that may or may not cover their actual needs.

This will attract young, healthy people, who are literally banking on not getting sick or injured. According to the nonpartisan Kaiser Family Foundation:

“The people who liked their pre-ACA plans were mostly healthy people who wanted cheap limited plans (and see no obligation for risk-sharing). Those folks will like this. Everyone else: no.”

Everyone else includes those who don’t want to gamble their physical well-being and financial future on the blind hope that they won’t really need serious health care. Worse, researchers at the Center on Health Insurance Reforms at Georgetown University explain how the underinsured will actually harm others:

“The losers would generally be people who want to buy a comprehensive insurance policy. Because once you give carriers flexibility to design the benefit package, they will do so to attract healthy people. No chump insurance company is going to be out there offering a comprehensive package, because then they’ll be stuck with higher-risk enrollees.” sees an even bigger problem:

“eliminating Essential Health Benefits would allow insurance companies to reinstate annual and lifetime limits on plans. Currently, plans cannot limit care that is part of the EHBs on an annual or lifetime basis. Such limits would be devastating for consumers with serious illnesses, like cancer.”

Timothy Jost, a health care expert at my school and your alma mater, Washington and Lee University School of Law, agrees:

“Since the ACA’s prohibitions of lifetime and annual limits and cap on out-of-pocket expenditures also only apply to essential health benefits, states granted a waiver would be able to define these protections as well. The changes to the lifetime and annual limits and to the out-of-pocket caps could potentially apply as well to large group and self-insured employer plans.”

Why then did you support the MacArthur amendment and vote for a health care bill that weakens health care? Were you so focused on partisan hatred of “Obamacare” that you sincerely did not recognize that the hastily assembled “Trumpcare” is worse?

The ACA, as you have repeatedly argued, is not getting the job done. The country needs a bipartisan solution. That’s only possible if leading Republicans like you explore options that ignore party lines and prioritize the needs of the uninsured and the over-charged. That’s an American problem. It needs a unifying answer.


Email #157: “charged more because of a pre-existing condition”?

According to a Quinnipiac University poll released yesterday, 64% of respondents approve of the ACA’s protections for people with pre-existing conditions, and 75% think it’s a “bad idea” to allow states to opt out of them. That includes a majority of Republicans–59%.

But despite this overwhelming support, I keep reading contradictory claims about whether “Trumpcare” would cover pre-existing conditions.

The President tweeted in April:

“New healthcare plan is on its way. Will have much lower premiums & deductibles while at the same time taking care of pre-existing conditions!”

He added on TV:

“Pre-existing conditions are in the bill. And I mandate it. I said, ‘Has to be.'”

Your form letters to me have also emphasized the importance of maintaining the ACA’s ban on pre-existing conditions, highlighting its inclusion in an early version of the American Health Care Act. But after that version did not have enough Republican support to make it to the House floor for a vote, the MacArthur amendment allowed states to waive protections. Under the amended AHCA that you voted for, insurers can charge much higher premiums for people with pre-existing conditions—but only if they’ve gone uninsured for two months. The House GOP website states this clearly:

“The MacArthur amendment to the AHCA does allow states to seek a limited waiver to allow the insurance companies to charge higher premiums for a person with a health condition only if they do not maintain continuous coverage.”

However, the GOP website also states:

“Americans should never be denied coverage or charged more because of a pre-existing condition.”

Or at least the website used to say that. The New York Times referenced that statement on April 26, and NBC referenced it on May 4. But when I went to the website myself over the weekend, I couldn’t find it. I presume it was deleted—and for good reason: it’s not true of the AHCA.

Unfortunately for those who voted for the bill, it does remain true morally. It shouldn’t matter if someone has no insurance for two months, or for any period of time. So-called pre-existing conditions shouldn’t be used against any American. Before the ACA, pregnancy was a pre-existing condition. Under the AHCA waiver, it can be again. So if an uninsured women gets pregnant and tries to sign up for insurance, she can be automatically overcharged.

The term “pre-existing condition” was invented by insurance companies for the purpose of limiting coverage for people who most need it. “Obamacare” struck the concept entirely. Now “Trumpcare” is resurrecting it.

Voters–both Democrats and Republicans–will remember that in 2018.