Popular vote loser Donald Trump can't get enough losing on Trumpcare, so he's been at it again, first with Sen. Rand Paul on the golf course and then with the Freedom Caucus he had spent last week bashing on Twitter. Apparently the tweet-bashing worked, he got the maniacs to talk to him, and they're reportedly agreeing on a plan that would break Trump and the Republicans' biggest promise: protections for people with pre-existing conditions.
The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act's insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.
The proposal is not final, but Mr. Meadows told reporters after the meeting that his members would be interested in such a bill. To pass the House, any bill would need to find favor not just with the Freedom Caucus, but also with more moderate Republicans. It would also need to attract the support of nearly every Republican in the Senate to become law.
This is what happens when you have a bunch of Republicans who've never cared about policy and don't know what the stuff they're talking about means then try to make policy. Community rating—the requirement that insurers treat everybody the same based on age—is the main thing that provides protection for people with pre-existing conditions. You get rid of that, insurers can charge outrageous premiums for sick people, again. Combined with getting rid of essential health benefits makes it just worse. It could mean someone with a chronic disease, say diabetes, could nominally buy insurance, but might have to buy the drugs and the medical supplies for treating it out of pocket. Or say, someone with cancer would have to pay for their own chemotherapy.
So technically they can say that they're keeping the requirement in the law for protections for people with pre-existing conditions, as Rep. Mark Meadows (R-NC) does, but it's a meaningless protection without the regulations forcing insurers to make it affordable. Meadows says he has an answer to that: "Those that have, you know, 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."
High-risk pools existed before Obamacare and for the most part failed. Coverage was really expensive and still had limited benefits and long waits. Yes, it drove down premiums for the healthy people when all the sick people were corralled in high-risk pools or just simply uninsured, but it drove up health costs for the whole system. And resulted in medical bankruptcies for people who had major medical events.
The plan would let states choose whether they wanted to keep the stricter protections of Obamacare, which means we'd see what happened with Medicaid expansion all over again. Rabid state Republican lawmakers would strip those protections away from their citizens, and the divide between red states and blue states would just deepen. Supposedly some House moderates have signed off on this idea because they think high-risk pools are enough, but whether it could garner enough support among Republicans is unclear. Same goes for the Senate. Particularly once they read in the news—or hear from their constituents in the next two weeks of recess—what this proposal would really do.