Junk insurance plan proves Trump doesn't care about your health Cheap insurance may sound good to currently healthy people. But experience shows these junk policies are bad for your physical and financial health.

Andy Slavitt | Opinion columnist

Show Caption Hide Caption 5 takeaways from Trump’s 2019 budget plan President Trump unveiled his 2019 budget plan, here are five takeaways that will affect the American people.

Republicans in Washington are so far proving they can’t be taken seriously to improve the nation’s health or health care system. After first submitting a budget that aims to force austerity on Medicaid and Medicare recipients to pay for last year’s tax cuts that are going largely to corporations and the wealthy, the Trump administration has now followed up with a new plan to allow insurance companies to sell junk health insurance.

Make no mistake, this is part of the continuing GOP drive to overturn the Affordable Care Act. It has gone from the headlines to the back pages, but to Americans with pre-existing conditions, or those living on the margins, the threat is just as real.

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Health and Human Services Secretary Alex Azar’s plan would allow insurance companies to sell the same junk insurance plans that existed before the ACA was passed. They are called junk plans because they allow insurance companies to deny coverage to people with pre-existing conditions, exclude expensive conditions, and place caps and lifetime limits on policies. To skirt ACA protections, the Trump administration is turning to short-term policies that don't have to meet the law's requirements.They're now proposing to define short-term as less than 365 days — say 364, up from the current 90.

The rationale from Trump and Azar is that insurance companies will be able to sell lower cost policies and give consumers more choices. This may sound good to some people, particularly those who are — for now – healthy. But we know from decades of experience prior to the ACA that these junk insurance policies have other consequences that are very predictable and very negative.

► Consumers who purchase these junk policies are going to be putting themselves at risk, both medically and financially. People will fill out long questionnaires to get medical care only to find out many treatments aren’t covered. Some 130 million Americans have pre-existing conditions, and millions more are diagnosed with new illnesses every year. No one is as good at reading the fine print as the insurance companies are at writing it. Junk insurance would reverse the precipitous decline in medical bankruptcies that has occurred since since the ACA took effect.

► For insurance companies, this is a license to steal. Limiting cancer coverage may attract more people with lower premiums, but it will prevent paying out those costly claims. And with these junk policies, the ACA requirement that insurance companies spend a majority of the premiums they receive on medical expenses goes away. Unlike under the ACA, insurers who appear the most attractive, but cover the least, become the winners.

► Insurance will become gradually less available, particularly for expensive conditions. Junk insurance plans have every incentive not to cover costly drugs and treatments and as soon as one company stops coverage, the rest quickly follow or risk losing their shirts. In addition to expensive drugs (aren’t they all), the many types of coverage likely to become routinely unavailable include maternity, cancer and mental health. Traditional ACA policies that cover these and other benefits will become more expensive and in many cases unavailable, as the non-partisan Congressional Budget Office found when it reviewed similar proposals.

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Rather than heeding the message from their failed efforts to repeal the ACA — and reinforced in poll after poll — that Americans want to see improvements and not repeal, Trump has decided to keep ripping apart the law, with or without Congress. And with help from Republicans, he has spent the last year taking actions that increase premiums. He cut off payments designed to reduce deductibles and co-payments, eliminated the individual mandate that broadened the risk pool and kept costs down, and reduced outreach to younger and healthier populations. An Urban Institute study found that junk insurance plans, along with the end of the individual mandate, will cause an 18% increase in premiums for plans that meet ACA requirements.

At this point it should be clear to even casual observers that the Trump administration has no serious interest in making health care less expensive and health insurance markets more stable.

The shame is that Congress could actually reduce medical costs for Americans. But that would require addressing the high cost of prescription drugs, paying hospitals and doctors in a smarter way and addressing the lack of competition among hospitals and insurers, particularly in rural America. Governors from both sides of the aisle have endorsed these kinds of measures. And Democratic senators led by Patty Murray stay at the bargaining table, month after month, hoping more than a couple of interested Republicans will show up.

There are real proposals to make health care more affordable and reverse some of the damage Trump has inflicted on insurance premiums, and they could make it into a spending package Congress must pass this month. But at this point, it’s hard to picture Republicans agreeing to premium relief without asking for unacceptable tradeoffs that further weaken ACA protections. If that turns out to be the case, Americans concerned about continued access to health care cannot be blamed for feeling their only choice is to vote them out.

Andy Slavitt, board chair of United States of Care and a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt.