Daugaard Would Consider Signing Trumpcare Waiver to Nix Rules on Pre-Existing Conditions

Have you had a heart attack, or a broken arm, or a baby? Governor Dennis Daugaard wouldn’t mind making you pay more for health insurance, maybe so much that you can’t afford it:

Gov. Dennis Daugaard said Monday that he would consider allowing South Dakota to opt out of the Affordable Care Act’s pre-existing conditions rules if a Republican repeal bill makes it through the Senate.

…The Republican governor said that many South Dakota residents have expressed a desire to keep the rules but might not realize the extent to which they can create a financial burden for the state.

“I think most citizens are probably not conscious of the cost so a responsible government has to weigh both sides,” Daugaard said. “We want to give as much benefit, particularly in health, as you can afford, but you have to be able to afford it” [Dana Ferguson, “Daugaard Would Consider Pre-Existing Condition Waiver,” that Sioux Falls paper, 2017.05.08].

South Dakotans want me to protect policy holders with pre-existing conditions? Hilarious!

Governor Daugaard acknowledges that “many” South Dakotans want to keep the ACA rules that prevent insurers from pricing folks with pre-existing conditions out of their insurance, but he dismisses that popular sentiment as ill-informed. The Governor here affirms the arrogance of South Dakota Republicans, who view any popular disagreement with their ideological agenda as error or ignorance that they can ignore.

But what’s that last line about affordability? If you can’t afford insurance, and if Grandpa Cheap thinks the state can’t afford to help, we’re just going to let you go bankrupt? Or die?

Dennis Daugaard, Kristi Noem, Mike Rounds, Donald Trump—they are the death panel.

If the Trump Congress offers waivers to states to do their dirty work against the Affordable Care Act for them, then it becomes more important than ever for South Dakota Democrats to field a passionate populist Democrat who will turn to South Dakotans and promise, “I will not take your health insurance away. I will not sign a Trumpcare waiver.”


58 Responses to Daugaard Would Consider Signing Trumpcare Waiver to Nix Rules on Pre-Existing Conditions

  1. Kinda like how we were “ill-informed” when we passed IM22, eh ?
    Keep it up. People are beginning to see these lizards for what they are.

  2. And we all saw this coming. While Republicans tell us they are the champions of state’s rights and giving power back to the states, they set things up so citizens are screwed at both the federal and state level. Soulless bastards. One and all.

  3. Mike Henriksen

    A question I honestly don’t know the answer to.

    Is being deaf a pre-existing condition?

  4. Roger Elgersma

    First they defund it, then they say it is broken because it is defunded, then they save us from having insurance. Republicans are only for the rich.

  5. mike from iowa

    Lying Paul Ryan exclaimed 800 billion dollar cut to Medicaid was not draconian to his way of thinking. Maybe he thinks like Dracons do.

  6. obama death panel bad, trump death panel good. trump only wants to help you get to heaven faster.

  7. LeaAnn Manke

    Not surprised. He refused to expand Medicaid, why wouldn’t he do this?

  8. “I think most citizens are probably not conscious of the cost so a responsible government has to weigh both sides,” Daugaard said. “We want to give as much benefit, particularly in health, as you can afford, but you have to be able to afford it”

    So it really does seem to come down to repealing the ACA for the tax cut to eliminate the wealthy’s burden of helping the poor. I am troubled about the switching of the pronouns in the last sentence – “We” want to give what “you” can afford. That is absolutely the private, free-market position, not the government’s position. We (the government) should give what WE (the taxpayers who fund the government) are ABLE to afford, and the ones currently paying the extra taxes for the ACA can afford to continue to help provide. As I type this, I realize that this the heart of government function and insurance in specific: those who can afford to pay help those who cannot so that nobody goes without.

    Are only the poor/uninsured held to this individual soul search of if their government funded benefit is worth taking other’s tax money to pay for? How does this not devolve into an absolute selfish view of resources and a complete rejection of any publicly funded good?

  9. And Daugaard is also a self-proclaimed Catholic that is not practicing the Social Teaching of taking care of the Common Good. Taking away the preexisting exclusion rule is not promoting a right to a healthy life and just creates hardship and suffering. Shame on Daugaard for wanting to devalue human dignity.
    Read up South Dakota Catholics, read up on your Social Teachings.

  10. interesting. Letta Lister, editor of the Black Hills Pioneer did a big op ed in today’s paper. I don’t think I’ve ever seen anything like this from their editors on ANY subject. She did hit the ACA pretty hard also, but……

    http://www.bhpioneer.com/opinion/do-your-job-congress/article_1069f1e6-3409-11e7-bdaa-7b1aa0ef1c06.html

  11. In this current era, when Christian conservatives push for discrimination of non-white people, woman, the LGBT community and now even those with pre-existing conditions, we need to forcefully remind them how the United States of America is more Christ-like than this ugly creature they have become – and also how it’s time for them to get reacquainted with a true sensation of inner shame.

    Do y’all think Jesus wants His people to have more, or less, health care? Suppose He wants His people to keep sinners from buying product at the local bakery? I dare any one of you phony Consera-Christians reading this to say “less” and “yes” as it would only prove what crack pots’ you have become. You’ve solidly misrepresented The Lord for decades, and it’s now time for you atone.

  12. I think you will find that Deaf falls under special needs, which Daugaard will willingly cut. It was his parents who are deaf, not their dummy. Republican think is that it can only happen to the other guy with bonus points if that other guy is a woman or a darkie. Double bonus points if it happens to a woman of color that is not white.

    Daugaard also knows that he is at the end of his thievery from the governors office, so he can put into law anything he wants to write in as the stench will fall to someone else. That someone else will then be able to say it was not their fault that they inherited it. republicans cannot govern, but this pos is gonna be their baby, crappy full diaper and all.

    One thing seems to be for certain, the voters will think they are gonna be rewarded for following the Judas Goat to slaughter are gonna feel the dull blade very harshly. Alan Grayson once said the republican health plan is for you to get sick and die soon, true that.

  13. You guys realize to get a waiver for me must have established another means for pre-existing conditions to be handled, like a high risk pool.

    Your apoplexy is baseless. But it is hilarious as you folks are certainly predictable in the ease you go bonkers.

  14. Troy, our concern is based on the fact that the high risk pools are woefully underfunded. Rep. Upton, sponsor of the amendment throwing $8B over five years at the states to entice them to do the GOP’s dirty work, admitted he has no idea how much money it would take to make those pools work. As I reported last week, AARP says it would take far more money than that, perhaps $178B per year.

    We are not hilarious, as you keep maintaining; we are doing arithmetic and looking at the past inadequacy of high risk pools.

  15. Jerry, I thought coming to the end of his political career would encourage Daugaard to break from his GOP orthodoxy and do the right thing. Alas, on this issue, he’s sticking with the cruel, corporate party line.

  16. Pre ACA, when I was trying to buy health insurance on the open market (a total foreign concept to me because I’d always had employer based health care), it was brutal. There was nothing out there that I could afford. NOTHING. so I ended up getting a junk policy that at least, if something happened to me, I would not lose my home and other assets (If I remember correctly, I was responsible for the first $25,000 of a major illness)

    When I went to apply for health insurance, I completed a 10 page questionaire on my overall health. My insurance agent told me to mark the “NO” box, under this question: “Do you ever get headaches?”. He said that he had seen many companies either deny or raise rates if this box was marked “Yes”. The companies argued that it could be a pre-existing condition. Sigh. Yes, let’s go back to those days!!! Gag.

    Healthcare in this country is a “for profit” business. THAT is one of major problems. Guess what happens when you have incentives in “for profit” business? There are winners and losers. The winners won’t be the patients, that’s for sure.

  17. barry freed

    The World these people long for already exists. It’s called Central America.

    The poor live in shacks and defecate in the street gutters while the rich live in sprawling mansions with massive courtyard gardens and luxury. The rich also have bars on their windows, armed guards watching, and are in fear of robbery, kidnapping, and murder every time they leave their compounds. They live in luxurious prisons, but they are prisons, nonetheless.

    Is that really how our Governor and Representatives wish to live, or have they only thought about the “being rich in a declining America” part?

  18. Eve Fisher

    Back to Dickens: “Are there no prisons? Are there no workhouses?” and, “Then let them die, and decrease the surplus population.”

  19. I like Pope Francis, but SD catholics make me sad that so many of them don’t follow the Teachings.
    Pope Francis telling the world healthcare should not be run like a business.

    http://www.catholicnews.com/services/englishnews/2017/health-care-is-not-a-business-but-a-service-to-life-pope-says.cfm

  20. CH,

    They may be underfunded but to get the waiver the State can choose to supplement them. The idea any state could politically waiver out of AHCA’s pre-existing condition/portability provisions shows just how out of touch you really are. Just aint happening in any state. Pre-existing condition/portability was a goal the GOP supported as much if not more than the Democrats. The primary Obamacare “goals” which the GOP didn’t accept was the mandate and related provisions.

    Your continued fall-back to any change in Obamacare is bad is going to result in one thing:

    A program which has mandates for all these good things (in your eyes) and nobody selling the policies. Thus, nobody is insured.

    So, your knee-jerk apoplexy continues to be hilarious. And, sad.

  21. Am I too jaded that I see all of this through a political lens? SDBlue’s comment got me thinking of how health care, politics, and states rights seems to be playing out in SD. Before the election, it appeared that the Governor had been warming to the the idea of expanding medicaid in SD; that expansion would help cover health care needs of SD citizens, and looked like it would be a manageable expense for the state with federal funding. That becomes a political problem for the GOP; having a state (Red state no less) become an example of how the ACA is helpful – the ACA that the GOP has demonized for seven years and pledged to repeal. Expansion efforts are ended when Trump is elected and it becomes clear that any expansion will not be funded by the feds. I get that; one does not start writing checks on an account that is going away.

    Now there is the waiver of pre-existing condition protections that will be a “state right.” Another attack on an ACA provision that helped protect the insured – but again, at a cost. This feels less like “states’ rights” and more about putting changes in the hands of the level of government most influenced by GOP partisanship. There would never be national support for making insurance worse for the insured, but you could get a good number of deep-red GOP states to make that happen.

    The REAL reason for all these changes seems now to have more focus. Before the Trump election is was partisan: the GOP CANNOT allow the success of a Democrat policy cornerstone – sixty-some defiant votes to repeal are taken to make that point. The GOP could not stop implementation, so they had to undermine Democrat’s political success of that policy. The election of Pres. Trump re-focused that attack on the ACA. Pres. Trump has now overtly made it about the $144,000,000,000 in tax cuts for millionaires over the next decade (Joint Committee on Taxation). Now I see a SD Governor, whose worse fears of a budgetary disaster are now manifest by the GOP, caught in the storm. It is the “starve the beast” strategy from the Grover Norquist/Ronald Reagan era.

    I think the GOP had a better chance of demonizing the ACA when it was purely partisan vitriol. Now that it is overtly about reducing the tax burden of millionaires, constituent attitudes are changing. The Governor’s comments display a forgone conclusion that the President’s agenda for wealth shifting in the US will be successful. The Governor’s comments reflect the economic realities of that wealth shift. I am more drawn to the Jimmy Kimmel position to see the repeal of the ACA as wealth shift, and to reject it on those terms.

  22. We’re not surprised that you would find the reality that people could lose health coverage b/c of preexisting conditions hilarious, Troy. If I was Christian I would pray for you that you find empathy for the millions that could suffer b/c of this.
    I also hope that you hear Pope Francis and the Catholic Social Teachings to value human dignity OUTSIDE OF THE WOMB.

  23. Porter Lansing

    Troy laughs a lot when people suffer. That’s like a character flaw, huh? One thing I think is funny is that two states only a couple hundred miles apart can have Governors with such different outlooks. Daugaard says without the waiver SoDak would go broke. Hick says the opposite.
    ~ Colorado Gov. John Hickenlooper blasted the U.S. House of Representative’s passage of the American Health Care Act on Thursday, saying that the bill, “threatens to end health insurance coverage for hundreds of thousands of hard working Coloradans.”
    ~ “Coloradans can blame this vote for leaving a $14 billion crater in our state budget over the next 10 years,” said Adam Fox, with the left-leaning Colorado Consumer Health Initiative.

  24. Jenny,

    Actually, it is sad you have no concept of what the state waiver means and the conditions under which it would be pursued and approved and then are willing to open your mouth so often to approve how deluded you are.

  25. Troy’s name calling of me is typical of what republicans do when they know they’ve lost the game. This is a horrible repeal bill and goes against everything the Catholic Social Teachings stand for and you know it but are too arrogant to admit it.
    If your mind wasn’t solely based on the technicalities of business and money perhaps you could see the light.
    The democrats have been handed the ball to win big in 2018.

  26. Cory has upgraded the discussions by getting rid of those obsessed with maliciously insulting him and his commenters, such as Sibby. Troy qualifies for that distinction. His remarks are like Trump’s tweets.

  27. Troy, do you see insurance providers dropping rates if a state opts out of the pre-existing conditions requirements to insure? Dropping higher risk clients HAS to reduce the cost of care, so will the remaining insured see the fair play of those returns in lower rates?

    Do you see then those with pre-existing conditions becoming wards of the state for health care, or would it be more of a single-payer state insurance system for those with pre-existing conditions? Is the risk pool another name for state-provided insurance? Who writes that coverage policy?

  28. Single payer health care in America or GFYS!

  29. O,

    Providers dropping rates? Yes I do because that is the rationale which would justify the opt-out (reducing rates for the general population). This is exactly the reason individual rates under Obamacare have gone up so much (individual insurance pool is saturated with pre-conditions and part of the pricing/underwriting pool).

    Your second paragraph are really good questions. I think different states will address it differently and from that diversity of approach we might find the best solution. In my mind, rather than becoming another name of “state-provided insurance”, I think the description which might do the best job will be “premium subsidized” privately underwritten insurance.

    The reason I think that might do the best job is the impact pools with particular profiles can ultimately have on cost containment without impacting care via rationing. Whether one is in a “normal pool” or “high risk pool”, there are means where the insured can choose risk (higher deductible) or actions (engage in risk reduction strategies like exercise) in exchange for holding down premiums.

    Example: Because of the rigidness of a national one-size fits all in the individual market under Obamacare, there is no flexibility to encourage behavior that reduces risks associated with pre-existing conditions. In group plans, you can have point system for benefit (e.g. lower co-pay) if you drop cholesteral/high blood pressure/lose weight but you can’t under Obamacare. But if the state’s take over and create their own pools (like a group plan), you can do this.

  30. RE Last Sentence: “You can do this” should read “It could be allowed if such a component was requested in the waiver and was approved by the feds.”

  31. Troy would call ANY version of expanding health care to more Americans a “one size fits all policy that just can’t work.”

    And that’s how you know Troy’s heartless and doesn’t understand the business nor public service of health care.

  32. o, Troy is like Raul Labrador stating “nobody dies because they don’t have access to health care”. republicans have no moral compass and they cannot govern. All they are good at is telling big fat fibs.

  33. Porter Lansing

    Wrong, again. Lower rates as an incentive for healthy behavior is a myth that resulted in a class action suit. Healthy behavior keeps your rate high and unhealthy behavior makes insurance companies charge even higher rates. Troy. Why does nearly every thing you post have an ulterior core of deception? What kind of people do business with you?

  34. Troy, has South Dakota ever had a pool for the uninsured?

  35. Troy, does the effect of separating pools into pre-existing (higher risk) and no-pre-existing (lower risk) create a zero-sum financial burden? If my rates go down $10.00 (random number) because my insurance company doesn’t have to cover pre-existing conditions and can reduce their payouts, won’t the state’s high-risk pool need that $10.00 to pay for the concentrated needs of that high risk pool they just acquired? Won’t the state need my $10.00 back (either from me or someone else)? My point is that I feel like there is a shell game of financing here. The same total funding is needed to cover premium costs, even though rates go down for some, taxes/rates/fees have to go up to cover others. Assuming nobody wants to put the sick on the streets or deny care or ration, isn’t the cost of care across the board the same before and after any opt out?

  36. I will also offer this: if SD would decide to opt out and that creation of a risk pool would require some state funding, does that finally break open the fair taxation debate? Can SD rain any more money from sales or property taxes? Will one more state responsibility force a core evaluation of how we raise money?

  37. Porter Lansing

    Exactly O … Separating the risk pools costs more than homogenization. Posting on FreePress has become just a game for this guy. Credibility? Gone …

  38. Porter, why would it cost more to separate?

  39. Troy, how will the reconciliation process begin for your insurance company to lower the premiums. All states have an insurance division that help to regulate premium prices. The insurance company must go to the state to either increase or to decrease premiums. The rule is an 80% loss ratio to premium collected, so the insurance company must show that they have paid 80 percent of each dollar in premium collected on claims. So you are now saying that the insurance company would suddenly be paying substantially less in claims to show they are making more of a profit in their corner of the healthcare market. Troy, how many times in your young life, have you seen a reduction in premium either before the ACA/Obamacare or after 2010.

  40. O,

    You are exactly right except you need to consider one thing: Multiple carriers all wanting not to be the fool stuck with the bad customers. That uncertainty/unable to actuarially risk out drives rates up.

    Plus, you have to consider that the separation means healthier people (ergo young people) can have lower premiums which brings them into the premium revenue stream vs. sitting on the sidelines/paying the penalty until they get sick.

    All of this is not science but will be ultimately resolved to some degree by trial and error in different state jurisdictions. The only “science” we have now is the Obamacare Exchanges for the individual market is imploding/disappearing and without change ultimately there will be more people uninsured (despite the best intentions of Obamacare).

    Jerry, as you said, rates have to go through state regulatory bodies. If pay-outs go down, they will reduce rates.

  41. Porter Lansing

    Overhead, O.

  42. Eve Fisher

    Troy says, “Because of the rigidness of a national one-size fits all in the individual market under Obamacare, there is no flexibility to encourage behavior that reduces risks associated with pre-existing conditions.”
    Ahem. (1) Trumpcare makes a baby born with a heart defect a pre-existing condition, and thus, does not have to be covered by insurance; there is no way to “behave” to reduce that risk.
    (2) After a certain age, there is no behavior that will keep you 100% healthy forever. You can jog, you can go vegan, you can do all kinds of healthy things and you’ll still have that heart attack.
    (3) The latest study shows that 2/3 of cancers are caused by random DNA mutations, not from risky behavior.
    (4) Trumpcare makes almost everything a person has ever suffered from, from headaches to c-sections to the flu, a pre-existing condition and, thus, you don’t have to be covered.

    The truth is, being human is a pre-existing condition. We are designed to get sick, to get older, to die. That is why we either have to start having compassion and pulling together or watch as the elderly, women, the handicapped, etc., are all thrown under a bus. And some day, you too will be elderly, and you too may be handicapped, and some of us are already women. Sarah Palin accused Obamacare of having “death panels”, but Trumpcare is nothing but one large death panel. To which I say, Medicare for all!

  43. Eve, not sure what you are saying but for the record I have and continue to advocate for health insurance portability and pre-existing protections.

    1) Not true. What passed the house does not allow a pre-existing condition to be a reason for denial of coverage or a factor in pricing coverage.

    2) Exactly. That is why we buy insurance.

    3) Not sure the relevance but I’m good with that.

    4) Not true. See #1.

  44. No worries Eve. I think what you wrote is perfectly clear. Troy doesn’t understand it because he is totally incapable of thinking outside of his box. That’s all that happened there.

  45. Right Adam, you can try, Eve, but Troy doesn’t understand because he lacks empathy.

  46. Troy, I’m jerking no knees. Reince Priebus’s and your suggestion, that passing the terrible GOP plan is fine because no state will actually do what it authorizes the states to do, is absurd. Dennis Daugaard just said he’ll do it. Dennis Daugaard just said we spend too much money on the current plan and he’ll spend less money, which means less coverage, less care.

    Your assertion that the status quo leads to fewer people covered has so far been proven wrong by actual practice. More people are covered now than were before the ACA.

    I don’t feel hysterical or hilarious. I feel I’m reading facts pretty coolly and rationally. It’s the Republicans who are making stuff up.

  47. But no, Anne, Troy hasn’t reached any level that warrants expulsion, and I doubt he will.

  48. Single-payer fits all in many countries. Bring it on. While we wait for that, stick with the Affordable Care Act instead of taking the backward step of Noem/Trumpcare.

  49. Hey, Troy, did you notice in March that the CBO said the non-group marketplace is not imploding?

    https://www.vox.com/policy-and-politics/2017/3/14/14921594/obamacare-implosion-ahca

  50. We can talk about risk pools and shifting costs all we want, but the problem is we don’t have the solid analysis… and neither did the Republicans who voted for this plan, and neither does Daugaard as he says he’d consider it. No one should be voting for the GOP plan until CBO shows us the numbers that say how much it would cost to make sure everyone who has insurance now still gets insurance post-plan, whether in the risk pools or on the individual market, without ending up saddled with premiums and out-of-pocket costs and lifetime costs that will leave them one heart attack away from bankruptcy.

  51. Troy has called me deluded, Cory, which was actually surprising to hear coming from him since he usually tries to be half way decent.
    He doesn’t like me telling SD Catholics that they’re not following their Social Doctrine, and that I don’t know anything about the Social Teachings but I can assure him I do. I was brought up in a very Catholic pro-life proud Democrat family that cherished life not only inside the womb but also after they’re born up until they take their last breath.

  52. Eve Fisher

    Troy, sorry, but under Trumpcare, health insurers are going to be allowed to use preexisting conditions to deny coverage. But please, keep telling yourself that everyone who needs health coverage will get it, and besides, you will never be unhealthy enough to be rejected.

    https://www.nytimes.com/2017/05/04/upshot/who-wins-and-who-loses-in-the-latest-gop-health-care-bill.html?action=click&contentCollection=The%20Upshot&module=RelatedCoverage&region=EndOfArticle&pgtype=article

  53. bearcreekbat

    Interesting discussion you folks are having. Troy asserts that the AHCA “does not allow a pre-existing condition to be a reason for denial of coverage or a factor in pricing coverage,” and argues that some of the conditions described by others would not qualify as pre-existing conditions. But there also seems to agreement that the AHCA has changed the treatment of pre-existing conditions in some ways, especially after a “lapse” in insurance coverage.

    Maybe Troy or Jerry or others can help answer the following question:

    Assume I am 30 years old and have never purchased health insurance. I become ill, go to the emergency room, and learn that my kidneys are failing, I will need dialysis and a transplant.

    1. Does the “lapse rule” even apply in this situation, and if so how much time under the AHCA do I have to buy health insurance before the insurance company is permitted to consider my kidney disease in determining the premium it will charge?

    2. If the “lapse” rule doesn’t apply to me because I have never purchased health insurance, may any healthy person defer buying health insurance until they develop a “pre-existing condition,” but not have to pay any more than someone my age who has no pre-existing condition?

    3. My parent’s insurance policy covered me until age 26. Since I did not buy health insurance afterward does this mean my insurance has “lapsed” under the AHCA and allows insurance companies to consider pre-existing conditions in setting premiums if I am injured and need expensive long term medical care? Or could I buy into the AHCA at the same cost as others my age?

    As for what constitutes a “pre-existing condition,” isn’t that a matter that the insurer defines in the insurance contract? Does the AHCA provide mandatory legal definitions of “pre-existing conditions?”

  54. Porter Lansing

    Tell us again Troy, why the CBO can’t be believed. The answer is the door hinge that holds up the entire Republican farce concerning Obamacare repeal .

  55. mike from iowa

    Want to know what wingnuts in DC really think about us peons? Whorin’ Orrin Hatch-etJob of Utah has some choice words for us m leeches.

    https://www.vox.com/policy-and-politics/2017/5/9/15599704/orrin-hatch-obamacare-repeal-public-on-the-dole

    Remember- korporate amerika is not on the dole, just us leeches.

  56. Mike, at least Orrin Hatch is being honest about his approach to health care reform. He’s not lying or pandering the way Trump did when he said he wants insurance for everybody that costs less and does more. He’s not sugarcoating it with pablum about the free market and more personal control the way Noem and Rounds do. He’s saying straight up that the ACA is a government handout making us leeches and that he intends to take benefits away from us for our own good.