Health care legislation is back on the table now that Congress has returned from its spring vacation. The White House is pushing hard to get something through Congress as early as this week. Although no bill has yet been introduced, the White House and congressional Republicans appear to have settled on the contours of a new legislative proposal.

Late last week, Politico published an outline of the latest GOP health care proposal, known as the “MacArthur Amendment.” A bill on the basis of the MacArthur Amendment would nominally keep in place two key features of Obamacare, the prohibition against insurers denying coverage to people with pre-existing medical conditions, and the “community rating” provision that proscribes insurers from charging higher premiums to people with pre-existing conditions.

But don’t be fooled. While the proposed legislation may appear to keep these key provisions of Obamacare alive, it’s an illusion. It is really designed to softly kill them.

It might not flip the switching that executes the pre-existing condition provision, but it leads the condemned to the electric chair, straps it in, and hands over the switch to the states.

While the proposed legislation may appear to keep these key provisions of Obamacare alive, it’s an illusion.

Why all the smoke and mirrors?

Because it is designed to create the false impression that Donald Trump is keeping his promise to retain the provision of Obamacare that prohibits insurers from denying coverage to people with pre-existing conditions, while it is actually helping him break it.

During the campaign, Trump vowed that although he would” absolutely get rid of Obamacare ,” he would retain the pre-existing condition provision:” I want to keep pre-existing conditions. I think we need it. I think it’s a modern age, and I think we have to have it .”

A proposed bill following the outline of the MacArthur Amendment would provide Trump with encompas to claim that he has kept his promise because that provision will nominally stay on the books. Under the surface, however, it provides an easy mechanism for the states to effectively neuter it by procuring so-called ” Limited Waivers” from the Secretary of Health and Human Service, Tom Price.

The Limited Waivers would allow states to opt out of two key requirements of Obamacare, the so-called ” community rating ” rules and the 10 Essential Health Benefits (” EHB “) that policies are required to cover.

While “community rating” may sound innocuous, it is in fact the mechanism that enables people with pre-existing conditions to procure affordable coverage. The Community Rating regulations require that insurers charge the same cost to everybody of the same age, regardless of whether they have pre-existing conditions. If insurers are required to insure people with pre-existing conditions, but left free to charge those people higher costs, insurance would become out of reach for many people who suffer from pre-existing conditions. The Obamacare Community Rating provision solved that problem by prohibiting insurers from charging higher prices to sick people.

Allowing states to waive out of the Obamacare Community Rating provision would be a drastic change of course back to the bad old days when insurers were free to deny coverage to anybody who might actually be likely to need it. It would price millions of people with pre-existing conditions out of the market.

Allowing each country to waive out of the Obamacare Community Rating provision would be a drastic change of course back to the days when insurers were free to deny coverage to anybody.

The new GOP proposal includes a fig leaf providing the affectation of cover for this unfortunate outcome. Nations wouldn’t be able to obtain a community-rating waiver just by asking for it. No, they would have to either establish a “high-risk” insurance pool, or participate in a federal high-risk pond that constructed coverage available to people with pre-existing conditions.

This fig leaf is as transparent as cellophane. Looking through it, one sees that high-risk insurance pools have a miserable track record. Sure, a handful of states have established successful ponds. But they are in the minority. Over thirty states have experimented with high-risk pools over the last four decades. Most have failed due to under-funding and/ or poor administration. In a comprehensive study of the history of state run high-risk ponds, the Kaiser Foundation find 😛 TAGEND

These high-risk ponds likely covered just a fraction of the number of people with pre-existing conditions who absence insurance, due in part to design features that restriction enrollment. State pools typically omitted coverage of services associated with pre-existing conditions for a period of time and charged premiums substantially in excess of what a typical person would pay in the non-group market.

So how do you feel about putting your medical care into the loving hands of a high-risk pool created by the Republican state legislatures of Arkansas, Alabama, Kansas or Oklahoma, to name just a few? Are you reassured?

But don’t worry, there’s a backstop! In order to procure a waiver, the state would have to ask Tom Price for permission. It would have to convince him that the purpose of the requested waiver is to reduce premium expenses, increase the number of persons with health care coverage, or” advance another benefit” to the public interest in the state.

Phew, that was close! And you were worried that getting waivers might be too easy!

Really, how hard do you think it will be for Republican-controlled states to convince Price that the purpose of the requested waiver would be to reduce premium costs, or “advance” some other supposed “benefit” to the state? Price has been one of the most strident critics of Obamacare in the Republican party. He is the author of proposed legislation to use nation sponsored high-risk pools to cover people with pre-existing conditions, so it’s hardly credible to think that he will disapprove any state’s application to do so, especially if the application comes from a state controlled by Republicans.

Community rating is not the only dead man strolling that would be nominally spared but effectively executed if the new GOP plan, or something like it, get enacted into statute. States would also be permitted to waive out of the Obamacare requirement that health care policies cover ten Essential Health Benefits 😛 TAGEND

ambulatory patient services emergency services hospitalization maternity and newborn care mental health and substance use ailment services prescription drugs rehabilitative and habilitative services and devices laboratory services preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care

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