The Pushme Pullyu of Healthcare – Preexisting Conditions

 “We’re going to have insurance for everybody”

Donald Trump, Washington Post interview, 01/15/2017

This was just a follow-up to the President’s earlier promises during his campaign. Preexisting conditions would be covered. Lifetime benefits would be banned. Prescription drug prices would tumble. Premiums and deductibles would fall. Nothing proposed by Republicans in Congress that would fulfill any of this. Nothing. Ever.

Republicans in Congress have voted well over 50 times to repeal the Affordable Care Act (the ACA aka Obamacare) since it was passed in 2009. While the Supreme Court gutted the requirement that individuals have healthcare insurance (subsidized for those who needed help) or pay a fine, there have been no successful congressional or judicial efforts to terminate the statute. Still, 20 Republican attorneys general have filed suit in a Fort Worth Federal District Court – known to be “GOP-friendly” – to find that the rest of the ACA, not vitiated by the above Supreme Court ruling, is unconstitutional and now unfunded without that individual mandate.

But even with GOP control of both houses of Congress, the last serious attempt by Republicans in Congress to repeal the ACA went down in flames when the late John McCain cast a deciding vote: “Sen. John McCain stunned much of the US and his party leaders on [July 27^th], when shortly before 2 a.m. ET he voted against a ‘skinny’ plan to repeal parts of the Affordable Care Act.

“McCain joined two other Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, who voted against the bill and quashed Majority Leader Mitch McConnell's plan to upend the US healthcare system after 20 hours of debate.” BusinessInsider.com, July 28^th. Ever since, President Trump, who promised affordable quality healthcare for all – directly or through his minions at the Department of Health and Human Services – has slowly dismembered the statute at every turn.

Even the Trump’s recent proposal to require drug companies to disclose their pricing in advertising as his only real effort to reduce related costs (the most expensive on earth) is likely to go down in flames. Pharmaceutical companies, citing free speech rights under the First Amendment, have made it clear they have no intention of following any such governmental mandate. Nevertheless, Trump’s efforts at sabotaging the rest of the ACA, his own braggadocio that he will watch that healthcare program collapse and help that happen, have been legendary.

Under the guise of providing “affordability,” Trump has recklessly granted conservative states “exemptions” (which are constantly being challenged, usually successfully, in the courts) from the rigorous requirements of the ACA. By allowing states to issue “skinny” plans – cheap insurance with exceptionally limited or zero coverage for serious health issues (including preexisting conditions, which the ACA expressly forbids) – Trump claims he is making healthcare accessible to all at very low prices. With smoke and mirrors, he essentially violates the ACA’s prohibition against refusing to cover those preexisting conditions.

Effectively, “skinny” plan consumers get policies that only cover specific health issues, but if that issue is not in the policy, is simply is not covered. Hence there is technically no ban on preexisting conditions… just that most health issues that are the most common preexisting conditions simply are not covered. So twisting to avoid all those cases lost in the courts, the GOP is back trying to gut the ACA without legislation… even as many GOP candidates are backing off their anti-ACA positions, favored by too many of their constituents, in favor of “fixing” the statute. You might not believe them, since most are still backing a president hell-bent to make sure universal healthcare coverage is no longer a viable government policy.

“The Trump administration Monday [10/22] took new steps to broaden the availability of health plans that don’t have to cover patients’ preexisting medical conditions, signaling that the federal government would support state proposals to promote more sales of these skimpier plans.

“Administration officials billed the move as a way to give more choice to consumers who are struggling with expensive health insurance… ‘Now states will have a clearer sense of how they can take the lead on making available more insurance options,’ said Health and Human Services Secretary Alex Azar, who has championed a host of efforts to loosen health insurance regulations established through the Affordable Care Act.

“But the latest administration proposal to weaken insurance standards comes as President Trump and Republican congressional candidates are intensifying their bid to convince voters that the GOP backs patient protections in the 2010 law, often called Obamacare… Just last week, Trump claimed on Twitter that ‘all Republicans support people with preexisting conditions.’

“And with just two weeks until the midterm election, GOP lawmakers who voted repeatedly last year to roll back the healthcare law and its protections are insisting they will preserve the rules on preexisting conditions…

“The new proposal from the Department of Health and Human Services and the Treasury Department would not explicitly scrap the law’s protections, which bar health plans from denying coverage to people with preexisting medical conditions.

But the administration plan would dramatically reshape rules established by the 2010 law that were designed to prevent states from weakening these protections.

“‘Republicans failed at repealing and replacing the ACA last year, but this new guidance gives states the flexibility to do much of it themselves,’ said Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, which studies health insurance markets… ‘The door is now wide open for states to do an end run around the ACA by creating a parallel market with lower premiums but fewer protections for people with preexisting conditions.

“Under current law, states may apply to the federal government for permission to redesign their insurance markets and keep federal healthcare aid as long as the redesign does not decrease the number of people with comprehensive health coverage.

“This guardrail was intended to prevent states from enacting plans that would leave consumers with inadequate insurance coverage, as frequently happened before the healthcare law was enacted.

“The new plan would change this guardrail by supporting state proposals that could shift people out of comprehensive health plans into skimpier plans that don’t cover benefits such as prescription drugs, mental health services and maternity care, and that can deny coverage for preexisting medical conditions as long as a state’s residents still have access to a more comprehensive plan.

“‘This guidance focuses on the availability of comprehensive and affordable coverage,’” the administration says in the proposal. ‘This … ensures that state residents who wish to retain coverage similar to that provided under the [ACA] can continue to do so, while permitting a state plan to also provide access to other options that may be better suited to consumer needs and more attractive to many individuals.’” Los Angeles Times, October 23^rd.

Yet this is only part of the overall GOP plan to reduce the massive new deficit caused by a tax reform act that rewarded the rich and most definitely did not “pay for itself” by addressing “entitlements” – GOP-speak for stuff like Social Security, Medicare and Medicaid. GOP Senate Majority Leader, Mitch McConnell, has made it very clear that to bring that deficit under control, those social programs are simply going to have to face stiff cuts in the next legislative session… but only if the GOP controls both houses of Congress. Hint!!!!

I’m Peter Dekom, and screwing the poor, the sick and the elderly seems to be a high priority for the incumbent party in power.