You may remember that a few days ago we were all sure that hell was finally freezing over. The event that occasioned this apocalyptic premonition was the fact that Rep. Billy Long (R-7) let us know that he wouldn’t support the latest iteration of the Republican Dump & Dupe Obamacare “repeal and replace” bill because it made no provision for those of us with preexisting conditions. This is the same high-living Billy Long who voted to cut SNAP food stamp benefits while claiming that folks in his district – where over 40,000 folks get food stamps – wanted more cuts. He’s not a really compassionate guy so the concern for those with preexisting conditions was a little unexpected.
I can only surmise that ol’ Billy has been hearing from plenty of riled-up constituents who will be hurt if Obamacare preexisting conditions provisions are eradicated. Without the protections written into Obamacare, the chronically ill can be denied health care insurance outright, or, when insurance companies are willing to write us a policy, they will be free to bankrupt us. The extremist Republican determination to return us to the pre-Obamacare status quo has rightly energized citizens who realize that Dump & Dupe will most likely mean we’ll be able to “choose” to die years earlier than we would have under Obamacare.
But never fear, like tigers, Republicans can’t really change their stripes. Billy thinks he has found a way to flim-flam those angry sick people who don’t want to die and still give his buddy, Donald Trump, the healthcare win he is demanding – regardless of the consequences for everyday Americans. An amendment that would allow states to do away with preexisting conditions protections will remain. But Congress will throw an extra $8 billion – over five years – into “high-risk pools” that, in theory, could be used to ameliorate the expense of the much higher premiums those of us with pre-existing conditions will have to cope with after the Obamacare repeal.
This is like throwing a dime at one of several men starving on the street and continuing on your merry way convinced that you have dealt with the problem of hunger in your community. As WaPos Paul Waldman notes, it “a laughably small amount of money compared with what would be required to insure this population” which consists of one out of every four non-elderly Americans; nor is it necessarily a continuing funding stream. According to Jean Hall, a physician and researcher at the University of Kansas Medical Center, underfunding is just one of the problems with the proposal to relegate patients with preexisting conditions to high-risk pools:
Recent proposals to replace ACA reforms with high-risk pools focus on using state-based programs, but historical experience with 35 state-based high-risk pools and more recent experience with the national Pre-Existing Condition Insurance Plan (PCIP) illustrate the problems with this approach. Even though state-based high-risk pools charged premiums of up to 250 percent of those charged to healthy beneficiaries in the individual insurance market, premium revenues paid just 53 percent, on average, of program costs. In addition to these high premiums, enrollees in state-based high-risk pools faced annual deductibles as high as $25,000 and annual coverage limits as low as $75,000.1 Past research indicated that high costs and limited benefits associated with high-risk pool coverage resulted in delayed or forgone care and adverse outcomes for enrollees. Many also accrued medical debt despite having insurance.2
For these reasons, use of high-risk pools in lieu of marketplace and Medicaid expansion coverage would result in greater state and federal costs, fewer people with preexisting conditions able to obtain coverage, and coverage that fails to meet the often greater needs of people with chronic conditions. Affording coverage would be particularly difficult for people with incomes below 400 percent of the federal poverty level, who accounted for 80 percent of the uninsured population with preexisting conditions prior to implementation of the AC
Even if Billy is able to placate his constituents in the short term, he’s not likely to get off scot-free. As Waldman observes, the fallout from Dupe & Dump will be severe:
The news media will be filled with horror stories of people who lost their coverage, and in some cases their lives, because of what Republicans did. If the bill passes, it will result in an outpouring of rage, particularly on the left but among all kinds of voters, that will vastly increase the chances of a Democratic wave in 2018 and even 2020.
Of course, there might be an upside. Come 2018, we may finally get rid of politicians like Billy Long.
*Edited slightly for accuracy (5/3/17, 3:58 pm)