Broken health care promises: The new Republican plan to gore pre-existing conditions protections

Republicans are desperate to repeal and replace Obamacare, so they're toying with screwing over the sick

Published April 20, 2017 7:00PM (EDT)

Paul Ryan, Donald Trump   (Reuters/Carlos Barria)
Paul Ryan, Donald Trump (Reuters/Carlos Barria)

Ever since the American Health Care Act slipped painfully and unmourned into the hereafter in late March, its corpse has been lying on a gurney in cold storage waiting for its executors to figure out what to do with it. Not content to simply dispose of the remains, Republicans in Congress and the White House have been periodically zapping the body with jolts of electricity and informing reporters that the American Health Care Act is still twitching with life and might actually get up and start tap dancing at any moment.

The latest development in this tortured effort to revive the Republican health care bill is a reported compromise amendment between warring factions of the House GOP. The AHCA failed the first time around because it could not muster enough support from hard-line conservatives in the House Freedom Caucus and more moderate Republicans: Each side had differing legislative priorities, and appeasing one faction meant alienating the other.

As The Huffington Post’s Matt Fuller and Jonathan Cohn wrote, there could be a deal between the two sides in the works. The proposal would allow states to opt out of existing rules prohibiting insurers from charging sick people more for coverage, thus making hard-line conservatives happy. It would also reinstate rules requiring insurers to cover “essential health benefits” (though those could also be waived at the state level), which would make moderates happy. There’s no firm agreement in place, as The Huffington Post noted.

Republicans have been flirting with changes like these for a while, and if they’re serious about moving forward with this “compromise,” then they’re making a huge mistake. Hollowing out pre-existing conditions protections (as this compromise would) might squeeze some votes out of the hard-right flank of the House GOP caucus, but it will also make the already unpopular AHCA even less palatable for the voting public. As I wrote earlier in April, Obamacare’s pre-existing coverage protections are extremely popular — so popular that a good chunk of people who back repealing the Affordable Care Act change their minds when they’re told the pre-existing conditions provisions would be scrapped.

Allowing insurers to charge sick people more for coverage and dumping people with pre-existing conditions into high-risk pools will mean that those people will lose access to health insurance coverage. Their premiums would shoot up by several thousand dollars. High-risk pools require huge amounts of state and federal subsidies to function properly and have historically been beset by funding shortages, which further limits access to coverage. Pursuing these changes would also mean that Republicans leaders will have to explain why they broke their promises that repealing Obamacare would not undo protections for those with pre-existing conditions.

“First, we should ensure that Americans with preexisting conditions have access to coverage,” President Trump said when laying out his health care priorities during his February speech to a joint session of Congress. Trump is on the hook for so many conflicting promises about health care that he’s bound to break some (or all) of them, and reneging on pre-existing conditions would be a big deal politically.

House Speaker Paul Ryan’s big push to promote the American Health Care Act included promises that people with pre-existing conditions would be absolutely protected. The House leadership’s “Better Way” fact sheet for health care states that “every American, regardless of their health status, has the comfort of knowing you can never be denied coverage” and that individuals will not be “charged more than standard rates — even if you’re dealing with a serious medical issue.” The changes under consideration would hollow out those pledges.

The important thing to understand is that the changes currently under consideration are not motivated by a desire to improve the legislation. They’re being thrown out there so that Republicans can tell their voters that they’re making good on campaign promises to repeal Obamacare. The urgency is clearly political: The White House is anxious to jam something through Congress so that the president can claim that he repealed Obamacare within the first 100 days of his administration.

Meanwhile, the latest Quinnipiac poll found that 60 percent of the Americans surveyed said they want the GOP to give up on repealing and replacing Obamacare, while a measly 36 percent said they want the party to keep pushing for it. Republicans’ health care plans are already wildly unpopular, and breaking their promises on pre-existing conditions will make their already bad policy still worse. But instead of just letting the American Health Care Act rot in the ground, they’re hell-bent on finding some way to breathe new life into legislation that almost everyone else prefers would stay dead.

By Simon Maloy

MORE FROM Simon Maloy