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Senate Republicans released an updated Trumpcare bill early Monday adding what had been noticeably absent from the previous version—any kind of way to encourage people to remain insured while it repeals the Affordable Care Act's individual mandate. What they came up with is this:
Starting in 2019, individuals who had a break in continuous insurance coverage for 63 days or more in the prior year will be subject to a six month waiting period before coverage begins. Consumers will not have to pay premiums during the six month period.
So you have to have continuous coverage for 12 months—any break in it at all and you can’t get insurance for six months. Clearly Republicans have no idea how health insurance—or real life—actually works. In a system that isn’t single-payer the idea of churn in the market is just a fact of life. People are constantly moving, changing jobs, having a change in income or other life experiences. Republicans want you to be punished if that happens by not being able to have health insurance for half a year.
The Better Care Act (BCRAP for short) says that insurance companies have to take all customers, including the sick one (though they weaken that requirement substantially by allowing states to waive all the essential health benefits in the law, giving huge, crazy leeway for insurance companies to price people with pre-existing conditions out of the market). This addition is a nod to the problem of an inevitable death spiral—only the sickest people who need insurance the most sign up for it, forcing premiums to skyrocket out of control. The bill had to do something about that, but as Sarah Kliff and Dylan Scott at Vox explain, that it "may run afoul of the chamber’s complex reconciliation rules." That question, and how McConnell will deal with it on the floor, remains to be seen.
Make your Republican senator feel the heat. Call their office EVERY DAY at (202) 224-3121 to demand that they say NO to ripping health care away from millions of Americans. No on Trumpcare. Then, tell us how it went.
In terms of what this means for actual people, it's more bad news. Kaiser Family Foundation's Larry Levitt notes that "If you're sick and have had a gap in insurance, your coverage wouldn't start until 6 months after you sign up. Even during open enrollment." That last part is key, it's closing a door that has been open for uninsured people to get coverage. He adds that he doubts "this encourages many healthy people to sign up. That requires a lot of foresight among people not very focused on insurance."
This isn't likely to make the Congressional Budget Office's numbers—expected to be released Monday afternoon—for people losing insurance and remaining uninsured any better for Republicans than it would have been without the change.