Trumpcare Means Leaving the Poor and Sick to Fend for Themselves

By @jonathanchait

President Trump with Health and Human Services Director Alex Azar. Photo: Chris Kleponis – Pool/Getty Images

Yesterday, the Trump administration unveiled plans to allow insurers to skim healthy customers out of the insurance pool by offering skimpy plans that last for up to three years. The legally dubious maneuver is the crowning touch on the administration’s persistent efforts to undermine the Affordable Care Act. Conservative intellectuals are justifiably ecstatic. “Wednesday’s rule came to be because dedicated people within the Trump administration worked hard to push federal policy in a libertarian direction,” exults Cato Institute scholar and onetime author of the “Anti-Universal Coverage Club Manifesto” Michael Cannon. Indeed, Trump’s attacks on Obamacare, taken together as a sum, provide a fair picture of the American right’s unique, social Darwinist philosophy of health-care policy.

Many people are either too poor or too sick to afford access to medical care. In every democracy in the world save the United States, a broad social consensus accepts the need to subsidize care for those people. This includes the conservative parties in those countries. Among right-of-center parties in the developed world, only the Republicans are so committed to anti-government dogma as to oppose measures to subsidize medical care for those who can’t afford it themselves.

But whenever Democrats have attempted to expand access to health care, Republican leaders have generally declined to present themselves as principled opponents of universal health care. Instead, they have promised they could accomplish the same goal in a better, cheaper fashion, without any of the painful trade-offs in the existing Democratic-authored proposals. No such plan ever emerged, in part because Obamacare was the most market-friendly way to accomplish the bare minimum objectives of any humanitarian health-care reform. The only space to Obamacare’s right involved punishing the poor and sick with medical and financial deprivation.

It is now clear that, on its own terms, Obamacare’s policy design worked. When the new marketplaces opened, insurers initially set premiums far lower than the Congressional Budget Office expected, and — as it turned out — lower than the market would bear. After correcting their initial under-pricing, insurers settled their premiums at a stable level that was both affordable to most consumers (especially in states that tried to make the markets work, as opposed to sabotaging them) and profitable for them.

Amazingly, the exchanges have survived despite eight years of legal attacks and administrative sabotage by both Republican state-level government and now the federal government under Trump. Republicans have eliminated outreach advertising for the exchanges, refused to issue required payments for insurers who accept disproportionately sick customers, and are now trying to lure healthy customers out of the exchanges, driving up costs for those who remain. The Republican line maintains that all these blatant attempts to kill the law are somehow the fault of the law’s designers. “Democrats want to blame the GOP for increases that are baked into the health law’s faulty design,” insists a pious Wall Street Journal editorial.

This is demonstrably false. A new study by Matthew Fiedler of the Brookings Institution shows that insurers in the exchanges have made a healthy 10 percent profit this year, and if the Trump administration had taken no additional steps to sabotage the exchanges, premiums would be coming down by an average of 4.3 percent next year.

A poll by Axios finds that, by a 20-point margin, Americans would rather keep Obamacare or do more than repeal it or do less. Republican politicians, caught between the unpopular extremism of their ideological vanguard in Washington and the moderate demands of the electorate, are retreating to evasions. In a New York Times story about Democrats focusing on health care, a Republican spokesperson gamely retorts, “A contrast between single-payer health care and our ideas — a more patient-centered approach — is a debate we fully welcome.” If you don’t know what “patient-centered” means, don’t worry. It has no meaning at all. Which is the point. The entire purpose of the phrase is to obscure the party’s health-care agenda.

Trump’s most recent step is to allow insurers to sell those skimpy plans with little coverage — excluding customers with expensive medical needs, who would be left in exchanges without healthy customers to help share the costs. This would provide some immediate cost-benefit to healthy customers, who would be free from cross-subsidizing the less fortunate. Of course, if they happen to suffer unexpected medical misfortune themselves, they will be out of luck.

The new Trumpcare plans will be cheap for people who are healthy enough to qualify. But they don’t cover much. If you find you’re having a baby, or need a weekend stay at a hospital, or even something as exotic as prescription drugs, you’re out of luck. The Journal editorial page insists this will all be fine, because “not everyone needs all benefits,” and also, “[t]he HHS rule also stipulates that issuers must prominently display a notice that the coverage isn’t compliant with the Affordable Care Act. Everyone will know what they’re buying.” Right, because everybody in America is already aware of what the essential benefits of Obamacare contain, and thus what their absence implies. Anyway, insurers are definitely going to make sure you’re aware of all the shortfalls and gaps in the product they’re selling you.

What is striking about the Trump-era Republican health agenda is the lack of policy ambition. Having spent years insisting they had an army of wonks who could design a better alternative to the Obamacare “train wreck,” the Republican plan of attack has dissolved into a rearguard sabotage campaign with no pretense of doing anything to help the poor and sick afford medical care. Health care remains a policy ground with which conservative-movement dogma cannot grapple.

57 total views, no views today

The stupidity of Trumpcare: Government will spend $33 billion more to cover 8.9 million fewer Americans, as premiums soar

By Michael Hiltzik

Feb 26, 2018 | 2:55 PM

The Republiclans taking away your health insurance: Vice President Mike Pence was flanked by Republican congressional leaders last year to talk up the GOP’s Obamacare repeal bill. The bill failed, but the Republicans found other ways to kill the ACA insurance market. (Shawn Thew / European Pressphoto Agency)

Those fiscal geniuses in the White House and Republican-controlled Congress have managed to do the impossible: Their sabotage of the Affordable Care Act will lead to 6.4 million fewer Americans with health insurance, while the federal bill for coverage rises by some $33 billion per year.
Also, by the way, premiums in the individual market will rise by an average of more than 18%.
Heck of a job.
These figures come from the Urban Institute, which on Monday released the first estimate of the impact of two GOP initiatives. The first is the elimination of the individual mandate, which is an offshoot of the GOP tax-cut measure signed by President Trump in December. The measure reduced the penalty for not carrying insurance to zero as of next Jan. 1.


Those affected by these large premium increases would be disproportionately middle-income people with health problems.
The second is Trump’s plan to expand short-term insurance plans, which don’t comply with many of the ACA’s essential benefits requirements and allow insurers to reject or surcharge people with preexisting medical conditions or histories.
The Urban Institute broke down the impact of Trump and Republican policies thusly:
— Eliminating the individual mandate, combined with such lesser acts of vandalism as eliminating cost-sharing reduction payments to insurers last year and eviscerating the outreach and advertising budget for the 2017 ACA open enrollment period: 6.4 million more people uninsured than under previous law, as the uninsurance rate climbs to 12.5% of the nonelderly population from 10.2%.
Health Insurance
Obamacare repeal bills could put coverage out of reach for millions of sick Americans  — Expansion of short-term non-compliant policies: 2.5 million more Americans without minimum essential coverage. Short-term policies, which were limited under the Obama administration to three months maximum and no renewals, would be expanded under Trump to last up to a year. Under the law, short-term policies don’t count as real Obamacare insurance.
— Premiums in the individual market: Higher by 18.2% in 2019 in “full-impact states” (41, plus the District of Columbia, which allow short-term policies under some circumstances.) Eight other states prohibit or limit the expansion of short-term policies, so their premium increases will be lower on average. Nationwide, premiums will rise by 16.4%. In Texas, North Dakota, Alabama, Nebraska and Arizona, the increases will exceed 20%.
— Because government premium subsidies rise in tandem with premium increases, the cost of subsidies borne by the government will rise by $33.3 billion next year, or 9.3% — to $391.4 billion from $358.1 billion under existing law.
The mechanism by which the GOP policies will crater the individual insurance market isn’t hard to understand. Both major initiatives — eliminating the individual mandate and offering bare-bones policies — siphon younger, healthier consumers out of the individual market.

Nov 15, 2017 | 9:45 AM  David Anderson, a health insurance expert at Duke University, understands why short-term policies will look like a good deal to young consumers feeling hale and hearty. Others, such as with preexisting conditions, won’t even be eligible to buy those plans, guaranteeing that higher-risk patients stay in the ACA pool. Anderson posits a 23-year-old earning $35,000. That consumer would think a full-scale Obamacare plan is a good deal only if he or she has “a significant medical history or reasonable probability of pregnancy.”
The economically rational response for the healthy in that segment would be to pay $100 or less a month in premiums and barely use any services over the course of the year. The danger, of course, is that anyone can get hit by a bus or find themselves holding an unexpected cancer diagnoses. Then they’re screwed.
“Those affected by these large premium increases would be disproportionately middle-income people with health problems,” the Urban Institute researchers said. That’s because “they prefer health insurance that covers essential health benefits, are unlikely to have access to medically underwritten short-term limited-duration policies, and are not financially protected by the ACA’s premium tax credits.”
Millions of others, including the U.S. taxpayer and families who need treatment and have incomes too high to be subsidized, also are screwed. That includes families with household incomes approaching or exceeding 400% of the federal poverty line: $48,560 for an individual and $100,400 for a family of four.
The damage estimate can’t be restricted to the immediate impact on individuals and families, the researchers observed. “As healthier enrollees exit for short-term plans, insurers will by necessity reexamine the profitability of remaining in the compliant markets. This may well lead to more insurer exits from the compliant markets in the next years, reducing choice for the people remaining and ultimately making the markets difficult to maintain.”
In other words, the Republican sabotage will continue to undermine health coverage in the U.S. The only alternative, it becomes clearer with every day, is some form of single-payer, Medicare-for-all coverage. That’s increasingly becoming part of Democratic Party orthodoxy, and it’s about time.


132 total views, no views today

Opinion: Healthcare Bill Is About The GOP Saving Itself, Not American Citizens

By Demetrius Harris on Sat, Sep 23rd, 2017 at 2:24 pm

The latest attempt by the GOP to replace Obamacare has nothing to do with providing coverage for American citizens. Members of the Republican Party are simply trying to save their political careers as opposed to saving the lives of the constituents that they serve.

The latest attempt by the GOP to replace Obamacare has nothing to do with providing coverage for American citizens. Members of the Republican Party are simply trying to save their political careers as opposed to saving the lives of the constituents that they serve.

After years of promising to repeal and replace the ACA package, the GOP is backed into a corner, and their response is to institute an insidious bill, that denies coverage to those who need it most. Pushing the bill out for vote without the benefit of proper examination and debate is a sign of underhandedness and trickery.

Republicans have placed their personal career goals above and beyond the specter of a comprehensive, inclusive healthcare package that would benefit the entire country. It should be mentioned that the effort to repeal and replace the ACA, was from the very beginning, a political maneuver designed to eradicate legislation by Barack Obama without merit.

Led by the father of all fools, Donald Trump, the GOP have attached their success as a party to hollow promises made without vision or expertise. The result is a bill that has GOP members like Iowa Senator Chuck Grassley, to openly admit that he intends to vote in favor of the bill, simply because Republicans have to deliver on their campaign promises. He says this while also conceding that the bill provides at least ten reasons to be voted down. In the eyes of the GOP, doing the despicable is better than breaking a campaign promise.

(Continued Below)

When you consider the potential for 32 million people losing coverage, UNLIMITED rising premiums and noncoverage of pre-existing conditions how can any GOP member vote yes for this package in good conscious?

Republicans who are seeing their political careers flash before their eyes in regards to 2018 midterm elections are operating without conscious, care or duty to country. The GOP have put votes and policy above the well-being of taxpayers. They have put the survival of party over the survival of your family.

Republicans have proved without a shadow of a doubt, that they are a collection of self-serving, conniving liars. Now that it’s clear that the drowning GOP has decided to use this reprehensible healthcare package as a life preserver for their party let’s make sure that they are the ones dead in the water in 2018. RESIST…


186 total views, no views today