The Republican vision for health care no longer has anything to do with repeal and replace. Instead, it's just get rid of Obamacare and all of its consumer protections so that cheap, skimpy insurance plans that don't cover anything can return. The whole idea of actually replacing Obamacare but keeping protections for people with pre-existing conditions is totally out the window with the ascension of Trump.
Here’s what the GOP has in mind: Weakened protections for people with pre-existing conditions. Skimpier benefits that leave out coverage for important medical needs. Less protection from financial harm due to illness. And a number of actions designed to make the Affordable Care Act's exchanges less stable for the millions of Americans who use them.
From the Trump administration sabotage of the open enrollment period last year, to the regulations it has proposed, to new state experiments to limit coverage, the Republicans seem to want nothing more than the return to the bad old days. This week it's new rules for short-term limited-duration insurance policies, which are being envisioned as plain old insurance available for the long term, but are cheap. They're cheap because they won't cover what a lot of people will need.
The policies exist now, but only for up to three months, a stop gap while someone is in a short-term gap between coverage. Trump wants to make them basically regular insurance available for a year at a time and is even kicking around the idea of making them renewable. We know from the existing plans that this is bad news.
The researchers at KFF looked at the short-term plans already on the market, what kinds of services they cover, and how robust their benefits actually are. The big takeaway: Yes, these plans are generally cheaper (their biggest selling point in the administration’s eyes), but that comes with a serious trade-off.
”Short-term health insurance policies offer lower monthly premiums compared to ACA-compliant plans because short-term policies offer less insurance protection,” the researchers wrote. [….]
But to be more specific: Short-term plans are much less likely to cover mental health and substance abuse treatment or prescription drugs—all of which must be covered by ACA plans. What is insurance, you might ask, if it doesn’t cover medications? This is also a setback for the ongoing effort to have mental health and substance abuse treated as equal to other physical health needs.
And none of the plans that KFF examined cover maternity care, which is also a requirement for Obamacare coverage.
Public comment on these proposed rules ends Monday, but public comment—even if it's 100 percent in opposition—is not going to guide the administration. These new year-long policies will be allowed just as soon as Trump's HHS can make it happen. People unlucky enough to end up with one can find themselves at risk for financial ruin, just like in the old days.
Out-of-pocket spending in plans the KFF researchers found in Miami, Phoenix, and Houston reached as high as $30,000 for just three months of coverage. The annual limits in out-of-pocket costs imposed by Obamacare in regular insurance are $7,000 for an individual or $14,000 for a family, but these new plans also are allowed to have caps in coverage, something Obamacare did away with. Some have caps as high as $250,000, but if you have a car accident or heart attack or cancer diagnosis under one of these plans, those caps will be reached really quickly.
This, as far as Republicans are concerned, is "insurance." This is what they've landed on instead of a replacement for Obamacare.