Health care dominated the conversation at Representative Kristi Noem’s town hall in Rapid City yesterday, where South Dakotans—well, maybe not the Boy Scouts and 4-Hers for whom the Congresswoman reserved seats in the front, but the rank-and-file voters filling the rest of the room—signaled their agreement with this blog that the best plan for health coverage is single-payer:
“We used to have 17 health insurance companies in South Dakota. We have two today,” Noem said, adding that, “We are a year or two away from having government run health care.”
In reaction to Noem’s apparent reference to a universal, or single-payer, health care system, many in the audience erupted in loud cheers and thunderous applause.
“And that probably answers a lot of people’s questions,” Noem said as the clapping died down. “Because you know that I am not in favor of government-run health care. We’re probably going to fundamentally disagree on that” [Mike Anderson, “Noem Faces Heat over Health Care Bill,” Rapid City Journal, 2017.07.05].
Questioned by a newly registered voter with diabetes about how she in her conscience could vote for a bill that would (Anderson’s words) “endanger coverage for people with pre-existing conditions,” Rep. Noem maintained the convenient dodge that (her words), “The bill that I voted for does not allow an insurance company to deny you for pre-existing conditions.” Technically true, but practically false—the state waivers in Noem’s bill would make it possible for insurers to price people with pre-existing conditions out of their product:
States may submit waivers to Washington to get out of complying with two elements of Obamacare that are preserved in the letter of the AHCA: essential health benefits, and community rating.
The essential health benefits provision, under Obamacare, requires insurers to cover 10 benefits, from prescription drugs to prenatal care, in any health care plan they offer. Community rating is a provision that prohibits insurers from charging any person more based on their individual health status — important if you have a pre-existing condition.
…If a state no longer makes insurers provide basic coverage for prescription drugs for someone with a chronic condition like HIV/AIDS, for example, a patient’s out-of-pocket cost would substantially rise, and reduce the insurer’s risk.
That, critics say, effectively makes any condition requiring treatment with prescription drugs a pre-existing condition that could make the cost of obtaining insurance prohibitively high.
…the premium hikes for people with pre-existing conditions could be much higher under the proposed law. That’s because, aside from the 30 percent penalty, people who had allowed their coverage to lapse might no longer be eligible for premiums based on community rating, but instead could be assessed premiums based on “health status” — meaning insurance companies could charge sick people much higher premiums than their healthy peers in the same age group [Sam Brodey, “Does the Health Care Bill the House Passed Maintain Protection for People with Pre-Existing Conditions, or Not?” MinnPost, 2017.05.11].
Noem also claimed that “We have a 124 percent policy premium increase that has happened in South Dakota since Obamacare was signed into law.” That’s the same figure Senators John Thune and M. Michael Rounds assert to divert our attention from their predations on our health care. The figure comes from a May 2017 report from the Trump DHHS and refers to premiums on the individual market from 2013 to 2017. But that report says its calculations “do not take into account premium tax credits” provided by the Affordable Care Act. This Washington Post fact check points out that those tax credits, which 80% of individual marketplace enrollees receive, mean many policyholders have seen steady or declining net premium costs. In Alaska, a state where Trump misquoted his own DHHS figures on a 203% increase in premiums, ACA tax credits have dropped the net premium cost for 86% of Alaskans in the exchanges to $93 a month, compared to $344 for individual market coverage in 2013.
Noem ignores that premiums this year on the individual marketplace would have been 30% to 50% higher without the Affordable Care Act:
…and consumers are getting better coverage for their dollar:
According to our analysis, average premiums for the second-lowest cost silver-level (SLS) marketplace plan in 2014, which serves as a benchmark for ACA subsidies, were between 10 and 21 percent lower than average individual market premiums in 2013, before the ACA, even while providing enrollees with significantly richer coverage and a broader set of benefits. Silver-level ACA plans cover roughly 17 percent more of an enrollee’s health expenses than pre-ACA plans did, on average. In essence, then, consumers received more coverage at a lower price [Loren Adler and Paul B. Ginsburg, “Obamacare Premiums Are Lower Than You Think,” Health Affairs Blog, 2016.07.21].
In other whoppers, Rep. Noem told KOTA-TV “nothing would change with Medicaid.” I invite readers to figure out the semantic acrobatics necessary to describe cutting $880 billion in spending, repealing the ACA’s Medicaid expansion, and converting Medicaid to a block grant with a per-capita cap means “nothing would change.”
It would be nice if we could count on a town hall with our lone Representative in the U.S. House for some useful facts. The only useful fact we got from yesterday’s Rapid City town hall is that Kristi Noem can’t tell the truth about health insurance and her vote to take it away from thousands of South Dakotans.