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Just in time for Easter, House Republicans are trying to resurrect their terrible health care bill. And what was revealed when the stone was rolled away from the tomb of failed legislation? An end to protecting people with preexisting conditions. (Metaphor fin.)




The New York Times has a pretty straightforward rundown of the changes in the new proposal, which are meant to satisfy the Freedom Caucus:

The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.


Two things about that: The à la carte approach to insurance undermines the whole point of health insurance, a system where the healthy are meant to subsidize the sick. (You could also think about this as the present day you subsidizing the future you that is sick or injured or managing a longterm illness or pregnant or whatever terrible ailments are awaiting you in life.)



Under that system, you might buy a plan only to learn that—after breaking an arm or getting a cancer diagnosis—your insurance doesn’t cover any of it. This kind of plan used to be called catastrophic coverage, and it doesn’t do shit for you if you’re sick, but it does keep you paying a monthly premium to your insurance company.

But the new change that’s being proposed, the end of community rating, gives insurance companies even more leeway to deny people coverage. It is essentially killing the current health care law’s provision on preexisting conditions without calling it that.

As the Times notes, without community rating, an insurance company can charge a sick patient as much as they want. They might not deny them coverage outright–something that used to happen before the Affordable Care Act–but they could put an astronomical price tag on it.


So under this plan, the very sick would need to pay a lot of money for insurance, or they will need to rely on state-subsidized high-risk pools. And as I’ve noted before, we’ve already tried high-risk pools, and this experiment is unlikely to go any better with the cuts to state Medicaid funding House Republicans are also pushing for:

These pools often had waiting lists, premiums that were sometimes 250% the cost of average premiums, and could come with unmeetable deductibles. They were insurance in name, not practice. Republicans in the House have claimed they could reform high-risk pools to avoid these problems, but it’s difficult to see how, at a moment when [House Speaker Paul] Ryan wants to block grant Medicaid and cut overall funding for government programs, states would have the resources necessary to help manage the costs of these high-risk pools without denying people care.


The Republican talking points on this bill frame it as about patient choice, but the choosers in this system are the insurance companies. Closing off access to affordable care for people in catastrophic circumstances is a death panel by another name.