Emerging GOP Obamacare Repeal Would Mean Sick People Pay (Much) More

Instead of controlling costs, it would shift them — onto the people with medical problems.

Now Republicans are trying to bring back Obamacare repeal. And the emerging deal would make a mockery of those promises ― by forcing people with medical problems to pay more for their health care, and in many cases leaving them unable to get insurance at all.

It would be a breach of faith, but also a revealing window into what Republicans who support this measure think the world should look like.

The whole point of health insurance is to protect people from financial ruin just because they happen to be injured or sick. Living with diabetes, battling cancer, recovering from serious injury ― these things are hard enough without having to worry that paying the medical bills will drive you into bankruptcy.

The Affordable Care Act was an effort, however imperfect and incomplete, to protect people from those problems. This Republican proposal would expose them all over again.

How the deal would gut protections for pre-existing conditions:

Politically speaking, it’s difficult to know how serious this effort is. The last attempt at repeal, the American Health Care Act, fell apart because it lacked the votes to pass in the House of Representatives. And a big reason was the objection of conservative Republicans, particularly those in the House Freedom Caucus, who felt it would have left too many pieces of Obamacare in place.

Now those House conservatives are telling HuffPost’s Matt Fuller, and others, that they are close to a new deal. According to the conservatives, it’s because the Trump administration has agreed to tear down a few more of the law’s provisions ― specifically, it would allow states to opt out of two of the law’s most important rules.

One of those rules requires insurers to cover a set of 10 “essential” benefits. These include everything from prescription drugs and hospitalization to mental health and maternity care.

Another rule prohibits insurers from charging higher premiums to people at high risk of getting sick. The wonky term for this is “community rating,” because it means everybody in the community is paying the same price, regardless of health status.

Getting rid of community rating in particular would eviscerate Obamacare’s guarantee of coverage to people with pre-existing conditions. If insurers can charge somebody with medical problems exorbitant premiums, then a guarantee of coverage is basically meaningless.

It’s difficult to know exactly how high premiums for people with pre-existing conditions could go if this emerging plan were somehow to become law, particularly since right now the “plan” is really just some concepts Republicans are discussing. But the insurance market that existed before the Affordable Care Act offers some clues.

Back then, insurers would routinely use higher premiums to discourage enrollment from people with health problems.

Conservative House Republicans are saying that, under the new plan, states would have discretion over whether to keep or ditch the rules on pre-existing conditions ― and that might sound less threatening. In reality, they would be under enormous pressure from insurance companies to ditch the regulations.

The emerging Republican plan would also offer extra money for “high-risk pools” ― separate insurance programs for people who have pre-existing medical conditions. These are supposed to be a substitute for the ironclad guarantee of coverage that Obamacare provides.

But states ran these programs in the old days and they were famously poor substitutes for what most Americans would consider standard coverage. Typically they had restrictions, including annual or lifetime benefits, along with far higher premiums or out-of-pocket costs than standard plans did.

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