The Right wing's never ending war on poor Americans and the sick is far from being over. After last month's monumentally embarrassing set back for the Trump administration, the president is now looking for another deal that would woo hard right House Republicans who thought the first proposal was too generous. While details are scant, it appears that the new healthcare bill would do away with even more vital Obamacare provisions protecting the most vulnerable Americans.
Republican Representative Chris Collins told New York Reporters that talks were ongoing between Trump and the House Republicans. Reported Bloomberg:
The details are still emerging, but the White House and Republicans are discussing a plan that would allow states to apply for waivers on some of Obamacare’s requirements, while still preserving its ban on excluding coverage of those with pre-existing conditions. States would have to show that their waiver “would improve coverage and reduce costs,” Collins said.
Whenever you hear a Republican say "improve coverage" or "reduce costs," this invariably means making coverage worse and passing costs off to the consumer, thereby making it more expensive. Mark Meadows, chairman of the House Freedom Caucus, which helped scupper Trump's original proposal last month provided more details on what any potential deal would look like. The Bloomberg report continued:
Meadows said that Obamacare’s community rating system, which prevents insurers from varying premiums within a geographic area based on age, gender, health status or other factors, would be eligible for the waivers. Such a change would allow insurers to charge sick people more for coverage.
The plan would rely on risk-sharing pools to be the “backstop” for people with pre-existing conditions who could be subject to higher premiums if the requirement on community rating were to be removed, Meadows said. “Marginally sick people” would pay the “risk cost associated with their coverage.”
“Those that have premiums that would be driven up because of catastrophic illness or long-term illnesses, we’ve been dealing with that for a long time with high-risk pools, so we believe in doing that is a way to keep premiums down for everybody to ensure everybody’s covered and ultimately where you don’t get priced out of the market,” he added.
Meadows said lifetime and annual caps weren’t discussed explicitly, because they aren’t the main drivers of insurance premium costs.
If Trump agrees to this, it would violate a key promise he made about insurers offering plans to people with pre-existing conditions. "We’re going to have insurance for everybody," Trump proclaimed on the campaign trail. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us...[Americans] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
This of course turned out to be complete nonsense. Trump's first proposal would have booted 24 million people off of their insurance plans and hit the poorest Americans the hardest, and the new configuration would be even worse. As the Huffington Post reported, scrapping the community ratings system would be catastrophic:
Ditching those protections would let insurers charge exorbitant rates for people with pre-existing conditions while also offering plans that don’t offer key services, like maternity care, hospitalization or lab services. Conservatives believe those people would then go into so-called high-risk pools for coverage, but the effect would still likely lead to people who need health care the most paying the most ― or not being able to afford coverage at all.
There is no deal as of yet, but we know what is on the table for a deal to be reached. If Trump wants to repeal Obamacare and replace it with something "great", he needs to put together a deal that caters to the far right, moderates, his own base and Democrats in the Senate. This is an almost impossible task, and not one Trump has the temperament or attention span to see through. Had Trump bothered to do his research before promising the world, he would have looked at Obamacare's long and tortuous road to fruition. Obama spent months delicately building alliances and making compromises to get something passed, whereas Trump has plunged head first into the deep end without understanding a) anything about health care ("nobody knew health care could be so complicated?") and b) the political process in Washington.
The new deal has yet to be put forward publicly, but we can almost certainly expect the worst. While the GOP's war on affordable health care for Americans isn't over, Trump's incompetence is at least making it all the more difficult for them to win.