One of the most popular provisions of the Affordable Care Act (aka "Obamacare") is the ban on insurance discrimination against people with pre-existing conditions. It's no wonder, then, that Republican politicians want voters to believe that their replacement bill, the American Health Care Act, does not return us to the pre-ACA world, where people with pre-existing conditions often found themselves unable to get anything close to adequate, affordable health insurance.
A new analysis by the Kaiser Family Foundation, however, shows that millions of Americans could return to those days when having a pre-existing condition meant not having decent insurance, or indeed, any insurance at all.
Republicans clearly want the public to believe otherwise.
House Speaker Paul Ryan put out a statement insisting, "Under no circumstance can people be denied coverage because of a pre-existing condition."
President Donald Trump has claimed that the AHCA "guarantees" coverage for people with pre-existing conditions.
Rep. Steve Scalise, R-La., argued that the AHCA "actually provides multiple layers of protection for people with pre-existing conditions in ways that Obamacare doesn’t do."
It's technically true that the AHCA, which passed the House earlier this month, has an amendment forbidding outright denials of people with pre-existing conditions and that people with continuous coverage — that is, no period of time when they are without insurance — are shielded from massive rate hikes. But there's a huge loophole built into the AHCA that, according to the Kaiser analysis, will allow as many as 6 million people with pre-existing conditions to be priced out of health insurance.
Under the AHCA, individual states will be allowed to let insurance companies charge whatever they want to anyone who lets their insurance coverage lapse for 63 days or more.
"Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015," the Kaiser write-up explains. "This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver."
“There’s no limit on how much more they can be charged and there are no assurances about what they would get or even if they would be able to get insurance under the bill," added study author Gary Claxton in a phone conversation. Claxton is a vice president and director of the health care marketplace project at Kaiser Family Foundation.
It is true, Claxton noted, that states that allow insurance companies to do this are required to "have some program to subsidize their costs." But he said the bill does not make clear what level of subsidy must be made available, or how affordable such a program should be.
In other words, 6 million people might find that their insurance premiums have tripled, quadrupled or more, and that the only other alternative is some minimally funded "high-risk pool" that doesn't really offer substantial coverage. It's a little like saying everyone is allowed "access" to a car, but then making it so that the only car some people can afford comes without tires or a transmission.
Understandably, the rapidly unfolding Russia scandal and the apparent coverup by the Trump administration is absorbing most of the news cycle. But while the specter of presidential corruption is a sexy story, the bigger danger right now comes from Republican policy — little of which is driven by Trump or his administration. Republicans would be just as eager to repeal Obamacare and kick millions of people off the insurance rolls under a President Marco Rubio or a President Jeb Bush.
The fact of the matter is that Republican senators are still plugging away on a bill to strip health care coverage from millions, a process that doesn't seem to have slowed at all just because Trump is immersed in a tumultuous scandal. The Senate has created a group of 13 leading Republicans who continue to meet three times a week to hammer out the upper chamber's version of the AHCA. Some of the ideas being floated would, if this can be believed, make the insurance system even worse for consumers.
Late Thursday, Bloomberg News reported that the House hasn't even sent its version of the bill to the Senate, because the Congressional Budget Office (CBO) hasn't had a chance to score it, which means it may not pass budget reconciliation rules. The whole situation reads like a dark joke, because it's widely believed that the reason Ryan rushed the AHCA to a floor vote in the first place was to avoid a CBO score, knowing full well that some Republicans would likely get cold feet the second the nonpartisan organization demonstrated how thoroughly the bill would jeopardize health care access for millions of Americans. Now there's a decent chance the House will have to vote on it all over again.
But really, there's more reason to worry that Ryan, who spectacularly failed to pass the first version of the AHCA earlier this year, has figured out how to play politics more effectively. Holding the vote before the CBO score won him the votes of a lot of Republicans who might otherwise have been reluctant. Now those Republicans are on the record as supporters of the bill -- and changing their votes after the CBO score comes out could invite a lot of uncomfortable questions.
That's why the Kaiser study and similar nonpartisan analyses are so important. Trump's scandals barely matter to congressional Republicans. If anything, they create a media distraction from what they're doing, which is crafting a truly nefarious work of health care "reform" without grabbing headlines for it. Even if Donald Trump is run out of Washington in disgrace — here's hoping! — the grim reality is that the larger GOP is still set to do serious damage to the health and well-being of millions of Americans.