Earlier today, the House passed the American Health Care Act, the Obamacare replacement plan President Trump long promised, by a vote of 217 to 213. As you read this, House Republicans are probably congratulating themselves on stripping 24 million or so people of health insurance with cans of frothy, lukewarm Bud Light.
The GOP’s first, aborted effort to replace Obamacare was bad. The not-so-cleverly disguised tax cut for the rich was so unpalatable to House Republicans on both the center and far right that no amount of bribes, threats or cajoling by the Trump Administration could convince them to "walk the plank for a bill that cannot pass the Senate" as Sen. Tom Cotton (R-AK) put it. The bill went down in flames, humiliating the president and depriving him of the highly-coveted signature piece legislation he could tout on his 100th day in office.
As bad as that version of the bill was, the re-animated zombie bill is significantly worse — or at least seems like it based on what little is known about its details. No hearings about it were held, and only the text of the old bill is available on the GOP’s AHCA website. But after huddling with the leaders of the far right-wing House Freedom Caucus and the more pliant legislators of the center right, Paul Ryan emerged Thursday with a plan to make insurance coverage even more expensive and less beneficial for millions of Americans. Here’s why:
No CBO Score
Twenty four million people were projected to lose coverage by 2026 under the previous version of the bill — we actually don’t know exactly how many people could lose coverage under the revised version because the Congressional Budget Office hasn’t scored the new bill yet, but most estimates suggest even more will lose coverage. We don’t know what impact the rewritten legislation will have on the deficit either. That’s because the new score isn’t expected until early next week. The reason Paul Ryan rushed to hold the vote Thursday rather than wait to learn the impact his bill could have on both the budget deficit and Americans enrolled in the Affordable Care Act? Probably because the CBO score provided enough ammunition to AHCA critics to kill the bill the first time around.
But it could be a tactical error too. Voting without a score is "a terrible mistake," former CBO director Douglas Elmendorf told Politico. "The members will have to explain why they supported something with a range of effects that people aren’t gonna like. At least if they waited for the estimate, they could make further changes to the bill that might respond to concerns."
New High Risk Pools
One of the reasons that the vote was able to take place at all on Thursday was because President Trump locked down the support of Rep. Fred Upton (R-MI) with the promise of $8 billion over five year to fund costly "high-risk pools" which group together the sickest patients, separating them and their healthcare bills from the general population. (One notable exception: those patients with pre-existing conditions can be denied coverage in high-risk pools. More on that later.)
Eight billion dollars might sound like a lot, but it will not be close to enough because high-risk pools are really expensive. As Vox recently detailed, before Obamacare the 226,234 people in the U.S. that belonged to high-risk pools – about 0.0007 percent of the U.S. population – generated $2.5 billion in healthcare costs in 2011 alone. According to Health industry consultants at Avalere, the amount of money allocated in AHCA is only enough to cover 110,000 people with pre-existing chronic conditions. Under the new plan, states could opt to allow insurance companies to charge sky-high rates to people with certain conditions if, for some reason, they temporarily lost health care coverage.
Coverage Will Get Much More Expensive For People with Pre-Existing Conditions
High-risk pools didn’t exist under Obamacare because instead of concentrating the health care costs of the sickest people in one place, it spread them around by compelling every American – no matter how healthy they believed they were – to get insured. Americans who didn’t buy insurance paid a penalty (2.5% of a household’s gross income, or $695 per adult and $347.50 per child). Republicans abhorred the so-called "Individual mandate," but the AHCA replaced it with a not-totally-dissimilar tax for losing coverage equal to 30 percent of your insurance premium. The problem, though, is that even though the bill includes language that says you’ll be penalized if you lose coverage, and language that says health care companies have to provide insurance to individuals with pre-existing conditions, it says nothing about how much those people could be charged — and because the new plan is a percentage of premium rather than a flat rate, the most vulnerable people could end up both unable to afford their premiums AND unable to afford the penalty for not being able to afford their premiums.
Per Politifact,"If the AHCA passes, it would allow for people with pre-existing conditions to be charged more per year for their insurance coverage – possibly to the tune of thousands or even tens of thousands of dollars more per year, some studies have found."
Employer Plans Could Get More Expensive Too
The zombie bill doesn’t only impact the health care plans of Americans who purchased through the individual market. As the Wall Street Journal reported today, the 100 million plus people with insurance through their employers may be impacted as well. A provision in the new bill could jeopardize the present cap on out-of-pocket costs in employer-provided plans.
Being a Victim of Sexual Assault or Domestic Abuse, Having a C-Section or Postpartum Depression Are All Pre-existing Conditions
The GOP's bill defunds Planned Parenthood for a year. And that's arguably not the most brutal affront to women's health. The measure also allows insurance companies to return to the dark age practice — outlawed by Obamacare — of charging the survivors of sexual assault and domestic abuse more for coverage. It could also mean increases for women who have had a c-section birth or suffered from postpartum depression.
Here are the other pre-existing conditions, per Sen. Sherrod Brown (D-OH), that you could be charged much more for: AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer's/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn's disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson's disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, "and ulcers to name a few."