Comedian Jimmy Kimmel went to the heart of the debate on pre-existing conditions during a monologue last week. He talked about the birth of his son Billy, who was born with a heart condition that required surgery within days of his birth. Billy Kimmel is doing fine now, but the situation was traumatic for Kimmel and his wife, Molly. At least, Kimmel noted, they didn’t have to worry about whether their child would be treated.
“Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you would never be able to get health insurance because you had a pre-existing condition,” Kimmel said.
Kimmel was referring to Obamacare’s most important benefit — the requirement that health care plans offer coverage to people with pre-existing medical conditions at the same rates healthy people pay. No longer would working people with chronic illnesses — or their families — be priced out of the quality health care.
President Donald Trump agreed with Kimmel when he was a candidate. Then Trump said he would repeal and replace the Affordable Care Act, but retain the mandate for covering pre-existing conditions. The first version of his American Health Care Act reflected that promise — and it never made it to a vote.
The version passed by House Republicans Thursday is different. Under the new version, states will be able to apply for waivers from the Obamacare pre-existing conditions mandates. To qualify, states would have to set up pools for high-risk individuals.
Or as Trump told CBS News’ John Dickerson Sunday, “We’ve set up a pool for the pre-existing conditions so that the premiums can be allowed to fall.”
There’s one little problem with this so-called remedy. It’s a gimmick that throws the hot potato where there are few if any hands are eager to claim it. How many governors want to incur the wrath of their voters by announcing that they want to get rid of a benefit that Kimmel and Trump himself in 2016 framed as American as apple pie?
Asked how many states were likely to apply for pre-existing conditions waivers, House Majority Whip Kevin McCarthy answered, “It could be a lot. It could be none.”
White House Deputy Press Secretary Sarah Sanders referred a reporter to the Department of Health and Human Services, which would not respond on the record. Be it noted, governors and state lawmakers are not clamoring for the opportunity to do what House Republicans would not do themselves.
Forget governors. “There isn’t a single insurance executive I know of who wants to get rid of pre-x,” said health-care policy guru Robert Laszewski, using the lingo.
So why did House Republicans go after a reform that even insurance executives don’t want?
A large chunk of the premium increases that hit the market with Obamacare are due to pre-existing conditions. In 2014, the Affordable Care Act caused individual premiums to increase 40 percent, said Laszewski, with about 30 percent due to pre-existing conditions.
Since then, premium increases have been in the double digits because Obamacare policies are so unappealing that healthy people aren’t buying, while sick people are clinging to their plans. In the industry, this is known as a death spiral. And it is the reason why insurers are running headlong from the individual market. Humana is pulling out of the market in 2018. After terminating plans in 11 states, Aetna just announced it will pull out of Virginia. The Trump White House is correct when it says that Obamacare is unsustainable.
Or as Trump put it during the Rose Garden celebration of the House passing the bill, “It’s dead. It’s essentially dead. If we don’t pay lots of ransom money over to the insurance companies, it would die immediately.”
Still, Trump seems poised to make the same mistake President Obama made before him — making huge promises on which he should have known his plan would not deliver.
Obama promised, “No matter what you’ve heard, if you like your doctor or health care plan, you can keep it.”
Trump says, “Yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it’s a great plan.”
But if the key to cutting costs is a stunt — asking state politicians to do to their neighbors what D.C. Republicans will not do from afar — better not to hold your breath.
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