President Skirting Obamacare with Skimpy State Plans Sold by Suspect Carriers
The Trump Administration, intent on crippling The Affordable Care Act’s value-added and cost-effective healthcare mechanism, outlined new “guidance” in November that loosens ACA state waiver restrictions, allowing states and insurance carriers to offer the same so-called “skinny”, short-term healthcare plans voted down in the Senate in July, 2017, by a trio of Republicans—Arizona’s John McCain, Alaska’s Lisa Murkowski and Maine’s Susan Collins—who sunk the Graham-Cassidy Affordable Care Act Repeal and Replace Act.
“I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums and how many people will be helped or hurt by it.”-John McCain
The Affordable Care Act was upheld twice by the U.S. Supreme Court in 2012 and in 2015. Chief Justice John Roberts cast the swing vote and wrote the majority opinions in both cases.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote in 2015, when affirming his 2012 precedent, which designated the ACA as a severance tax rather than an entitlement, as is social security.
The Center for Medicare and Medicaid Services, which implements the health law, says the Trump waivers will create “more choices and greater flexibility in their health insurance markets, helping to bring down costs and expand access to care,” said Health and Human Services Secretary Alex Azar.
Iowa Governor, Kim Reynolds, applauded the waivers, saying they offered low-priced insurance her constituents can afford.
A Trump diehard and right-to-lifer, Reynolds in May signed the state’s fetal heartbeat law, outlawing abortion as soon as a heartbeat is detected approximately six weeks after pregnancy.
Twelve Attorneys General Challenge Junk Insurance
One of the Trump Administration’s coverage options encourages smaller businesses and individuals to form association health plans (AHPs).
Attorneys general from 11 states (including the red state of Kentucky) and the District of Columbia, filed a federal complaint challenging the Trump administration’s waivers that expand availability of association health plans that are below the standard of ACA care.
“These junk plans offer substandard health coverage and threaten our local insurance market,” AG Karl Racine, District of Columbia’s Attorney General said.
“With this lawsuit, we’re taking action to protect our residents’ access to decent, affordable coverage,” Racine said.
Patients on the Hook for Millions
The Commonwealth Fund states, these “unauthorized health insurance companies intentionally fail to comply with state and federal law regarding insurance regulation; they collect premiums for nonexistent health insurance; they do not pay claims, and, ultimately, they leave patients with millions of dollars in medical bills.”
“Since 2001, four of some of the largest unauthorized plans have left nearly 100,000 people with approximately $85 million in unpaid medical bills and without health coverage,” the Commonwealth Fund notes.
The Wall Street Journal’s Stephanie Armour reports, “A bill introduced by California Democratic state Senator Ed Hernandez would ban such stripped-down policies within the state. Insurers such as IHG, eager to sell the short-term plans, have urged legislators to reject the Hernandez bill, insisting many people want short-term coverage.
“New Jersey’s Democratic Governor Phil Murphy in May signed legislation imposing a penalty for not having coverage, starting next year,” Armour writes, adding Maryland is also banning cheap plans that lure healthy customers away from the ACA marketplace, draining the funds from older people who most need insurance; and don’t cover essential benefits, such as maternity care.
The New Jersey penalty is $695 for an adult, or 2.5 percent of an individual’s or family’s income, whichever is greater—for a maximum penalty of $2,085, Armour writes.
One New Jersey voter told Armour, “I’m not happy [with the fine] and think New Jersey residents made a big mistake by voting in this governor.”
Blue States Resistance
Blue states are “in a race of sorts to launch regulations before the corresponding parts of the ACA are knocked out”, Armour reports.
“In various ways,” she says, “Hawaii, Rhode Island, Connecticut, California, Washington, Minnesota, New Mexico, New York and Colorado are all blocking GOP initiatives or publicly debating how much of the law to preserve.”
In a bipartisan effort, Senators Tennessee Republican, Lamar Alexander, and Washington State Democrat, Patty Murray, are aggressively pursuing legislation to preserve Obamacare, as they attempted to do since Republicans tried last year to ram Graham-Cassidy repeal and replace through Congress.
Outgoing Florida Democratic Senator Rick Nelson—who narrowly lost Florida’s midterm race to Governor Rick Scott—pleaded with Congress to halt Trump’s efforts to violate Obamacare law with rules that sidestep Congress, the Supreme Court decisions under which Obamacare is considered settled law, as well as executive branch’s rule-making process.
“The administration should better look at their situation and do the opposite of what they have been doing, Nelson said on the Senate floor.
“I ask the American people to demand that the Trump Administration stop undermining the ACA. We should be working together in a bipartisan way to make the ACA work better, not trying to kill it,’ Nelson said,” Armour reports.
Slashed Enrollment Funding and Medicaid Work Permits
Meanwhile Democrats blame Republican for plunging enrollment, “down sharply on the federal health insurance marketplace this fall, and the consumer assistance groups that help with sign-ups think they know why, Kaiser Health News reports.
“They don’t have the staff to help as many customers as before because the Trump administration slashed funding,” Kaiser states.
The Wall Street Journal’s Armour writes the growing disparity between states may be even more pronounced than it was before the ACA passed in 2010.
“Among conservative-leaning states, Arkansas, Kentucky, Indiana and New Hampshire are moving to impose or have imposed work requirements in Medicaid. Idaho’s governor wants to let insurers sell plans that don’t cover benefits that are mandatory under the ACA,” Armour concludes.
Although Trump has done an about-face and now champions pre-existing health conditions, work requirements have knocked people with pre-existing conditions off the Medicaid rolls, leaving uninsured people who are too ill to work with costly diseases that clog hospital ER’s and precipitate hospital bankruptcies
Individual Mandate Repeal Takes Effect in 2019
The individual mandate, the fine imposed on consumes who fail to pay their healthcare taxes, was eliminated as part of the 2017 Tax Act, and supported by McCain and Collins, hobbling a central pillar of Obamacare.
Trump was triumphant when the individual mandate was crushed, tweeting, “Obamacare has been repealed.”