Here's your regular reminder that no matter what Donald Trump, Paul Ryan, and Mitch McConnell promise you about keeping Obamacare's protections for people with pre-existing conditions, it's not going to happen.
Republicans are almost certainly going to use the same language this time around that they used in the reconciliation bill President Obama vetoed earlier this year. Because to do otherwise would be way too much work and that's the only thing they've actually been able to agree on in years, so that's what they're going with. It repeals the individual mandate that requires people buy insurance or pay a fine and eliminates the subsidies and cost-sharing reductions in the bill after two years. Here's why that matters:
Both elements are critical for insurers to meet the ACA requirements that they offer coverage to people with pre-existing health conditions and not charge them higher premiums. Without the penalty and the subsidies, the individual market would destabilize and ultimately fail, as the Urban Institute's new analysis of the approach in the vetoed reconciliation bill shows. Under that bill, which left the pre-existing condition protections and the other ACA "market reforms" in place, an estimated 4.3 million people would drop their marketplace coverage right away because they wouldn't face a penalty for being uninsured. Healthier people would be the most likely to go without health insurance, delivering a financial hit to insurers that would lead many to stop offering marketplace plans or sharply raise premiums.
To keep healthier people’s premiums relatively low and encourage them to enroll, while eliminating the penalty for not having coverage and subsidies that defray people's costs, the protections for people with health conditions would need to be far weaker than they are today. For example, even if insurers still couldn't deny coverage to people with pre-existing conditions, they'd likely be able to use other tools to shift costs onto sicker people, such as once again charging higher premiums based on a person's health status, excluding coverage of specific conditions, or refusing to cover key services and medications that people with high-cost conditions use.
That's the bottom line.
Republicans say maybe they'll have "continuous coverage" protection for people with pre-existing conditions, saying that as long as they maintained some period of coverage—18 months to a few years, depending on the proposal—they couldn't be denied insurance or have to pay higher premiums based on their health status. But that's not reflective of reality, as CBPP points out. "Before the ACA, 36 percent of Americans aged 4 to 64—89 million people—went without coverage for at least one month between 2004 and 2007, and about one-quarter of that group lost coverage more than once, one study found.” It's a really fluid market, with people constantly flowing in and out with life changes—new jobs, unemployment, marriage—and the continuous coverage restriction just doesn't work.
Republicans also say they'll have "high-risk pools" to keep the sickest people covered. It's not a new idea, and we know it doesn't work because it's not a new idea. They are simply not affordable for most of the people who need them. This means about 52 million Americans are in danger of losing their health insurance if they end up having one of those life changes. That's more than one-quarter of the insured population.
All because Republicans are completely allergic to the idea that maybe some "undeserving" people get a little bit of help in life by getting affordable insurance.