Message to GOP on Trumpcare resuscitation effort: it’s dead; get over it

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The News:

House Speaker Paul Ryan announced a Republican agreement Thursday (April 6, 2017) on legislative language that he said will bring the chamber closer to passing a bill to repeal and replace the Affordable Care Act.

@SpeakerRyan brings new #health plan to repeal and replace #Obamacare Click To Tweet

Ryan, after canceling a vote on repeal legislation that divided his caucus last month, said the House will add language to the draft bill to create a new federal risk-sharing program that he said would lower premiums and add protections for people facing challenges getting access to affordable care, according to USA Today.

The $15 billion proposal for a Federal Invisible Risk Sharing Program (pdf), as described in a memo from House Majority Leader Kevin McCarthy (R-CA), is designed to help states reduce premiums by reimbursing health insurance issuers for high-cost individuals–those with significant health problems–beginning in 2018.

The proposal by Reps. Gary Palmer of Alabama and David Schweikert of Arizona–both members of the conservative Freedom Caucus–is modeled after a program in Maine, and Ryan said it brings House Republicans closer to a final agreement on how to repeal and replace Obamacare.

“This promise is just too important and the consequences of inaction are too dire for American families for us to give up,” Ryan said. “The amendment makes the American Health Care Act a better bill and the caucus is still working on other consensus ideas.” The divide between the Freedom Caucus members and the more moderate wing of House Republicans is “narrowing quickly,” he said.

Many Freedom Caucus members refused to support the earlier version of the bill, and efforts to add language to court them led Republican moderates to turn against the bill as well.

Democrats have pushed for increasing reimbursements to insurance companies for high claims under the Affordable Care Act as a way to entice insurers into the individual market and bring down costs.

But House Minority Leader Nancy Pelosi, during a Thursday news conference, said the new Republican proposal only puts a “Band-Aid on that horrible, monstrous bill.”

The California Democrat said, “They are desperate to keep Trumpcare alive, continuing their campaign to raise massive costs on seniors and hard-working families.”

Steve’s Take:

In a worrisome sign about their ability to face the loud political music last month, Republicans are even starting to concern those of us in the media about their fundamental sanity by seemingly throwing reason and caution to the wind and taking another shot at repealing and replacing the Affordable Care Act.

You heard me correctly. The White House is working on a new version of a replacement bill that would scuttle protections for people with pre-existing conditions, in an effort to cut insurance premiums and win the support of the conservative Freedom Caucus.

To those of us who report on these events week in and week out, it’s as though they missed the news that the GOP’s American Health Care Act is dead.

Max Nisen at Bloomberg says it best: “It’s as dead as it was the day House leaders halted a planned vote on the bill. And it will remain dead through inevitable further attempts to jolt it back to life.”

Republican House Speaker Paul Ryan continues to insist the bill is in a “conceptual” stage.

Nisen says, “Think concept car–something that has only the faintest connection to reality and little chance of actually coming to life.”

It must have been cause to pop a Rolaid or two for Speaker Ryan to see the brand new Gallup poll Tuesday, showing President Obama’s Affordable Care Act with majority approval for the first time ever–55%. Approval is up 17% among independents and up 10% with both Democrats and Republicans. That’s sounding to me like borderline consensus.

Gallup’s analysis of the data suggests that “politically, it creates a major obstacle to Trump and Congress’s ongoing efforts to change or replace the law. In future elections, it could turn the GOP’s opposition to the law from an asset into a liability. More importantly in the daily lives of Americans, it might mean that the most sweeping changes to the nation’s healthcare system in decades will remain the law of the land for the foreseeable future.”

Remember when the first iteration of Ryan’s Trumpcare bill had just 17% approval? Now that Trump himself has gotten involved in the process–or so he claims–the approval is almost guaranteed to sink even lower.

As Margot Sanger-Katz explained to New York Times readers just as Trump and Pence were weirdly crowing about another bill on the way, this one undermines one of the things about Obamacare that virtually everyone–except insurance companies—is fond of: coverage for pre-existing conditions.

All through the campaign and the “debate” over repeal and replace, Trump–and most top congressional leaders–have assured the American people that their plan:

“would retain a crucial, popular part of the health law: the promise that people can buy insurance even if they’ve had illnesses in the past.”

As part of his deal with the Freedom Caucus extremists Trump is abandoning that pledge.
As blogspot DownWithTyranny points out, the terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations.

They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

The ability to opt out of the benefit requirements could substantially reduce the value of insurance on the market. A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs.

The second opt-out would make the insurance options for those with pre-existing conditions even more meaningless.

Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted.

If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.

There is a fundamental reason that many conservatives want to scuttle these provisions. Simply put, since they help people with substantial healthcare needs buy relatively affordable coverage, they increase the price of insurance for people who are healthy. An insurance market that did not include cancer care–or even any cancer patients–would be one where premiums for the remaining healthy customers were much lower.

The “new” bill would reportedly let states opt out of the ACA requirement that insurers cover “essential health benefits,” including things like prescription drugs and maternity care. And it would give states the right to let insurers charge sick people significantly more for insurance. It could make comprehensive health coverage basically unaffordable on the ACA’s individual market and shift costs to the most vulnerable Americans.

These changes directly contradict Trump’s campaign promise to protect those with pre-existing conditions. They would turn off moderate Republicans, while still possibly not being harsh enough to bring the entire Freedom Caucus on board. In the unlikely event the bill is twisted sufficiently to satisfy conservatives, the changes would then render it even less passable in the Senate.

What the Trump administration hasn’t learned quite yet is that continuing to focus on health care won’t increase investors’ hopes for tax reform or avoiding a budget-related government shutdown.

Bottom Line:

It’s still unclear whether Trump intends to actively sabotage the ACA, hurt it via neglect, or figure out ways to improve it. And this indecision is the real destabilizing force for the healthcare industry as insurers try to decide whether to remain in the ACA’s individual market in 2018.

Steve's Take: #GOP’s #healthcare promises haven’t amounted to diddly Click To Tweet

Occasionally, political drama is intriguing, even fascinating. But this move to resuscitate Trumpcare is a thorough waste of our time, effort and energy. There are too many other pressing matters about which we citizens should weigh-in and make our voices heard both with our local legislators and federal reps.

Investors, meanwhile, should focus on genuine attempts to bolster the ACA, rather than the GOP’s inability to accept that seven years of healthcare promises haven’t amounted to diddly.

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