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The Spectacular Trumpcare Trainwreck Proves We Can Never Trust Republicans With Healthcare Reform

Republicans are either clueless about how insurance actually works or they are counting on their constituents being clueless about it.

Republicans have had a rough time getting to a vote on their shiny new American Health Care Act, (as of this writing, Paul Ryan just ran to the White House to tell Trump the bill doesn't have enough votes to pass) because even a number of their own members recognize it for the piece of garbage that it is. As conservatives have noted, the bill is in some ways an "Obamacare Lite" plan. But in other ways it is a monstrosity that threatens to cause affordable insurance coverage to vanish while claiming to save insurers and the insured from the (made up) Obamacare "death spiral."

Republicans are either clueless about how insurance actually works, just don't give a damn who is negatively impacted by the repeal of Obamacare, or (most likely) some combination of the two. And there may be no bigger example of their clueless malevolence than the AHCA's removal of Obamacare's "essential health benefits" provision.

The Affordable Care Act requires that all insurance policies sold on the insurance exchanges cover ten categories of care. In other words, insurers cannot currently offer policies that fail to provide coverage for things like substance abuse and maternity care. The AHCA would do away with that requirement, which would mean the return of cheap, "junk" policies that cover little to nothing.

People who grumble about being forced to pay for coverage that they will never need are being exposed to what those of us with large group policies provided by our employers have had for years. My group insurance covers any number of things that I have never used. Part of my premium pays for others on the plan who may need help dealing with drug addiction, something I have never required treatment for. And part of their premium pays for my cancer treatment, which many of them will never need.

Most of us in group plans are fine with that arrangement. Because there are so many of us paying into a system that covers so many things, the cost isn't prohibitive for any of us. But Republicans and the people who vote for them just can't seem to understand that when we help others we often also help ourselves.

Former Republican staffer Rodney Whitlock sees the move to eliminate the essential health benefits provision as a backdoor way to bring back insurers' prohibition of "pre-existing conditions." He told NPR,

"Protections for pre-existing conditions only work as long as plans have to cover the services you need because of your pre-existing condition. By repealing [essential health benefits], a plan may no longer have to cover those services, making the protection potentially meaningless."

So, if you have a pre-existing condition an insurer still could not refuse to offer you an insurance policy. But they would no longer have to offer you a policy that covers your condition. It's the latest example of "Catch-22." Insurers will simply offer policies that don't cover certain high cost conditions, then charge extra to those who want the coverage. And that extra coverage will come with a high price tag. There's no way around that, because the pool of people buying coverage for things like maternity care or substance abuse will be much smaller than it is now.

In the insurance world there are only two types of coverage that everyone is guaranteed to benefit from. One is life insurance. The other is health insurance -- if that health insurance covers things that actually need to be covered; not just hangnails and sinus headaches. Failing to spread the cost of expensive care around to a larger group of people means that once again more Americans will needlessly die from treatable health conditions, and the insurance companies will continue to laugh all the way to the bank.