by Matthew Casper
With the House passage of the American Healthcare Act of 2017, jubilant House Republicans have once again taken to the airwaves to blanket the country with their current talking points regarding the effects of their legislation on the people of the country. As I covered in my first Media Memo on this topic, there are ready talking points and questions that the media, Democrats, and knowledgeable and caring citizens should have at the ready regarding the entirety of the bill, and now in addition, this final passed version that now heads to the Senate.
It's worth noting that the problems with the initial bill all still exist; these questions are add-ons specific to the talking points that the Republicans have landed on. (At the risk of self-promoting, I believe that it's worth going back and recommitting the responses outlined in the last memo to memory, as they continue to be useful in the debate.)
1. One of the most common complaints and issues that has been raised in the media and by elected Democrats is that the AHCA removes protections for those with pre-existing conditions related to guaranteed issue of benefits. Let's get one thing straight: this is not true. That is, it is not accurate in its phrasing, and this allows the GOP to correct the interviewer and come across as credible in their presentation. The House bill does indeed offer protection against denial of insurance benefits in their bill.
SEC. 137. CONSTRUCTIONS.(b) NO LIMITING ACCESS TO COVERAGE FOR INDIVIDUALS WITH PREEXISTING CONDITIONS. —Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions
The problem is that it doesn't matter. What the bill does is allow insurers to charge whatever they want for these people, which Obamacare prohibited through a mechanism called community rating. According to several studies, those with existing conditions -- including pregnancy -- would see their rates increased by thousands and even tens of thousands of dollars. Diabetes would add approximately $6,000 to the average insurance premium paid. Pregnant? That'll cost you between $17,000 and $20,000 more. Rheumatoid Arthritis would increase premiums by more than $25,000. Some cancers would result in premium tack-ons of almost $150,000. Per year. This is the biggest piece of what makes the new version of the bill even worse than the original. The analysis that premium costs will go down for the younger and healthy relies on insurance being so expensive that the sicker and the old will fall out of the insurance pool, resulting in lower costs for the insurance companies. While this bill includes some money to help with that, even ultra-conservative think tanks who underestimate the cost of so-called high risk pools say that $8 Billion over 5 years isn't enough to deal with the costs of those who'd end up in these pools. In fact, some analyses find that this wouldn't be enough for many/most single states to cover those who will find themselves without affordable care options.
Response: You say that those with preexisting conditions are protected in this bill, but your biggest complaint about Obamacare was that if insurance cost too much, people couldn't use it. Yet this bill guarantees that insurance will cost too much for people with preexisting conditions to even purchase. This leaves people far more vulnerable than they were before. How is that possibly a good thing by your own standards of what makes insurance accessible?
2. Republicans are minimizing the effect of this bill by saying that waivers have to be sought by states, and there's no guarantee states will seek them let alone that the Secretary of Health and Human Services will grant those waivers. The reality is that these waivers are basically automatic. In fact, they've written default approval into the bill.
(2) DEFAULT APPROVAL.—An application submitted under paragraph (1) is approved unless the Secretary notifies the State submitting the application, not later than 60 days after the date of the submission of such application, that the application has been denied for not being in compliance with any requirement of paragraph (3) and of the reason for such denial.
And just for good measure, there's also an automatic "pocket approval," which says that if the Secretary doesn't approve or deny the waiver application within 90 days that it will be automatically approved for "no more than ten years." Got that? The Secretary doesn't have to do a thing in order for the waiver to take effect for a decade. And even if the Secretary does take action, the state is automatically granted such a waiver unless they don't meet the ridiculously slanted requirements that we will examine at in a moment.
It's then important that we look at what such a waiver entails and what effects they will have.
These waivers are granted for several areas: first, the ratios that capped the amount that insurers could charge older Americans, which was no more than 3 times the amount charged to younger, healthier ones; second, the essential health benefits (outpatient care, emergency room trips, in-hospital care, pregnancy and maternity care, mental health and substance abuse care, prescription drug benefits, rehabilitative services, lab tests, preventive services, and pediatric services) that were mandated by the Affordable Care Act; and to allow current health to factor in greater ways into formula of premium rates.
All three of these would result in financial catastrophe for those who are older, less affluent, and of course, sicker. In addition, states are actually financially incentivized to seek these waivers, as the amount of money that states will have to deal with their medical needs will be going down as a result of other changes to the bill, and they can only access more money by segregating the sick, eliminating these essential health benefits, and weakening protections for their populations. And these waivers don't just apply to those who get their insurance through the individual market or exchanges. In fact, they will effect every single person who receives health insurance in the entire nation. Whether you get your insurance through your employer or through the government exchanges, these changes will affect the type of coverage -- and more importantly, the types of protections -- that you have.
And what does it take for a state to apply for such a waiver? The state must "specify" how removing these protections will meet any one of a list of qualifications, including the catch-all of "Increasing the choice of health plans in the State," which can be met simply by establishing a waiver in the first place.
: Republicans are minimizing the number of people affected by the waivers included in this bill. This bill actually incentivizes states to apply and guarantees that their applications will be approved even if the Secretary does nothing. How does increasing the cost, making it harder for the old and sick to afford insurance at all, and incentivizing states to water down coverage help improve the healthcare system in this country?
3. The most third most-common refrain being repeated by all Republicans from the President in down is that this bill needed to be rushed through because we are in a crisis with healthcare.
As I covered in my last column on Trumpcare, this is nowhere near true. But it is a handy place to start in exposing the Republicans supporting this bill as cynical hypocrites. In fact, every Republican leader who complained about the process of passing Obamacare but voted for this should be forced to wear their statements as millstones of shame, and people should be ready with a handful of statistical facts to parry back Republican lies about it.
Response: Republicans and you complained that Obamacare was rushed through -- after numerous CBO scores and a year and a half of bipartisan public development and debate. So how do you now justify voting on a privately developed plan that the only scoring we have says results in more-expensive insurance that covers approximately 25 million fewer people -- and that scoring is on a bill that experts say was better than the one you passed? You call it an emergency now, but since the passage of Obamacare, healthcare costs are actually lower, healthcare inflation has decreased to the lowest rate in modern history, the uninsured rate is at an all-time low, and costs have come in below projections. So is it that important to cut taxes for the wealthy at the expense of so many Americans and at the cost of making healthcare even more expensive for all that you can't even wait to analyze what effect this will have on your constituents before voting on it?
There are many more issues with the bill, from the reductions and changes to Medicaid to pay for an almost $1 Trillion tax cut, to the structural changes to Medicare that roll back the progress that's been made over the last 7 years related to changing the model of service, to the giveaway to insurers that allows them to spend less on health costs while raising prices on consumers. Each of these have answers, but it takes a little bit of homework to beat back.
For the sake of all those whose lives are literally on the line, we must do that work and demand that the mainstream media does the same, holding accountable those who bring lazy talking points to the country via their airwaves.