On Monday, Donald Trump agreed that the Affordable Care Act is the standard for good health coverage legislation… at least when it comes to pre-existing conditions:
President Donald Trump said Monday the Republican health-care bill being negotiated in Congress ultimately will protect Americans with pre-existing conditions as well as Obamacare does.
“I want it to be good for sick people. It’s not in its final form right now,” he said during an Oval Office interview Monday with Bloomberg News. “It will be every bit as good on pre-existing conditions as Obamacare” [Margaret Talev, Jennifer Jacobs, and Jennifer Epstein, “Trump Wants Health-Care Bill to Protect Pre-Existing Conditions,” Bloomberg, 2017.05.01].
Remember: you cannot read that sentence without also reading, Obamacare is not a disaster; it works so well that new legislation must be at least as good.
Of course, the House Republicans’ zombie health care bill did not protect people with pre-existing conditions from being priced out of their coverage, so Donald Trump actually had to do some work this week, promoting Michigan Representative Fred Upton’s amendment to restore that protection. Trump now supports adding another $8 billion to the GOP plan to keep folks with pre-existing conditions from losing their insurance. That’s on top of $15 billion added to bolster state risk pools that will have to pick up the slack if Congress kills the ACA.
Unfortunately, that’s not even close to meeting Trump’s Obamacare standard:
According to one estimate, it would take $178 billion per year to adequately fund state high-risk pools, where people with preexisting health conditions would go to access health insurance coverage.
However, the AHCA would only provide $15 billion annually for two years and then taper off to $10 billion annually for seven more years. And, this is not even a dedicated funding stream; states could also use this money to pay for other things like health promotion activities, dental and vision care, or behavioral health treatment. In previous analyses, we found this level of funding woefully inadequate.
Apparently, some federal policymakers feel the same way. That’s why the Upton Amendment, as reported, adds in another $8 billion over five years in an attempt to shore up financial help for people with preexisting conditions.
But even this is not enough [Lynda Flowers, “Protecting People with Preexisting Conditions: Upton Amendment, as Reported, Is Not Enough to Get the Job Done,” AARP: Thinking Policy, 2017.05.03].
Besides, the return to risk pools is a return to the dysfunctional status quo ante that drove the reforms of the Affordable Care Act:
“Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions,” said Andrew W. Gurman, president of the American Medical Association. “The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage — if they are able to obtain coverage at all” [Tami Luhby, “High-Risk Pools Won’t Match Obamacare Protections for Pre-Existing Conditions,” CNN:Money, 2017.05.03].
Speaker Paul Ryan is putting the Republican health plan up for a vote tomorrow, before Congress takes an 11-day break (they just got two weeks off for Easter—I want that job!). The vote count is still close, in part because the bumbler in the White House has focused on twisting arms in Congress and not engaging any of the major players in providing and using health insurance:
Though Trump this week has dialed up reluctant Republican lawmakers on the repeal bill, his hands-off approach to the health care industry is a far cry from the Obama administration’s concerted effort to win over the groups as Obamacare was drafted. The Obama White House wound up cutting deals with every part of the health care industry — insurance companies, doctors groups, hospitals and the pharmaceutical industry — to get the Affordable Care Act passed in 2010. Though Republicans panned those deals as giveaways and they even made some Democrats uncomfortable, they were key to holding the Obamacare coalition together all these years.
“Every single health care group was deeply invested in the [ACA],” [AARP lobbyist John] Rother said. “It couldn’t be more opposite today” [Adam Cancryn, Sarah Karlin-Smith, and Paul Demko, “Deep-Pocketed Health Care Lobbies Line up Against Trump,” Politico, 2017.05.03].
Trump has accepted Obamacare as the standard for covering people with pre-existing conditions; he could stand to accept Obama as the standard for negotiating a passable health care plan.
But really, Trump should just admit that he has no plan and that Republicans can’t come up with one that’s better than what we Democrats crafted under President Barack Obama.