They Won’t Stay Dead! should be the motto for Trumpcare (and, I suppose, my own). While the newest version of the AHCA doesn’t quite pit the dead against against the living, it does set the not-yet-dead sick against the healthy. This walking dead plan would allow states to gut the ACA’s bans on discrimination against people with pre-existing conditions, replacing them with the really-most-sincerely-dead concept of risk pools.
President Trump is hungering for a “win.” The congressional Republican, meanwhile, are craving for a big accomplishment — or anything at all — to show their constituents as they adjourn for their Easter recess. Thus, they tried (and failed yet again) to revivify the corpse of repeal-and-replace.
And speaking of death, that’s what would result if the GOP ever manages to raise the AHCA from the legislative grave using the elixir of risk pools. Republicans love risk pools because they give the illusion of allowing access to healthcare to the very people who need it the most…without actually providing it.
According to Richard Figueroa, a staff member of California’s Major Risk Medical Insurance Program:
People would literally pass away while they were on the waiting list.
And even for those who survived the loooong wait, only the well-off sick can even afford to purchase these risk pool simulacrums of insurance coverage.
Many years ago, before I was awarded Medi-Cal disability coverage, I looked into California’s risk pool. The wait list was measured in years due to ever lowering enrollment caps. Coverage was hugely expensive — as high as 37% above individual insurance market rates — while at the same time offering extremely limited benefits, with few plans to choose from.
The abysmal California risk pool — coming to a state near you! — was on life support by the time Obamacare made it nearly obsolete. As an excellent Kaiser Health News article in Time Magazine detailed:
California’s program had strict limitations — a $75,000 annual maximum on health claim payouts, with a $750,000 lifetime maximum.
People with hemophilia would often exceed the lifetime maximum and not be able to get further coverage, said Cheryl Fish-Parcham, private insurance program director for the advocacy group Families USA.
I almost certainly would’ve exceeded the annual maximum with my coma, assuming I had somehow managed to scrape up the money to pay for the exorbitant risk pool premiums and deductibles.
Can I auction a kidney on eBay?
Risk Pools: Another Kind of Catastrophic Coverage
Surely California’s risk pool was an outlier, some may think. Well, if you want to believe that, don’t ask Minnesota resident Craig Britton, who paid $18,000 a year into his state’s risk pool, the Minnesota Comprehensive Health Association. Said Britton:
That is catastrophic cost. You have to have a good living just to pay for insurance.
Okay, but Paul Ryan proposed pumping $15 billion into the risk pools. That should be plenty, right? Not exactly.
As NPR reports,
The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.
The fact is, the kind of pooled risk Ryan and his congressional minions are most worried about is the electoral kind. While accounts differ over whether Reince Priebus threatened Paul Ryan’s position as speaker or merely warned more generally of looming electoral losses, the mood as the Chief of Staff cajoled the House leadership into raising Trumpcare from the grave before their Easter recess was reportedly “intense.”
The idea seems to be that the Trump administration could fool moderate Republicans into accepting the evisceration of community ratings, which prevents insurance companies from charging people with pre-existing conditions more than the healthy as well as “guaranteed issue,” as in, you’re guaranteed insurance, even if you need it.
These are among the most popular of Obamacare policies. The very ones, by the way, that Trump has repeatedly promised to protect. I suppose when The Donald promised there wouldn’t be people dying on the street, he really meant that the dying wouldn’t be allowed on the streets.
Meanwhile, ultraconservatives are trying to turn the criticism heaped upon them for killing the AHCA against moderates. They claim these “liberal Republicans” were the ones truly at fault for blanching at the damage that undead bill would wreak upon the sick, poor, and aging. Indeed, everyone but the rich.
But wait, there’s more! Zombie Trumpcare also brings back the ditching of essential benefits from the moldering corpse of the AHCA. So, as the New York Times’s Margot Sanger-Katz put it:
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.
Apparently, Trump thinks the American people are so dumb that they’ll believe he’s keeping his promise to preserve the prohibition on pre-existing condition exclusions, even as he makes it impossible for the sick to afford that insurance or obtain vital medications and services under it.
Fortunately, “moderate” Republicans aren’t about to dive right into risk pools. They too are worried about their jobs — especially ones from districts won by Hillary Clinton.
But unlike the hardliners, moderates aren’t salivating at the cost savings of 24 million losing their healthcare — a million more than if Obamacare were repealed without a replacement. They actually speak about the human costs as if they were more important.
Shocking, I know.
When diving head first, you should first watch for the dangers that lie below the surface.
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