On Sunday, President Donald Trump told John Dickerson on CBS’ “Face the Nation” that any health-care bill he would support would “guarantee” protection for people with preexisting conditions. “Preexisting conditions are in the bill,” he declared. “And I mandate it. I said, ‘Has to be.’ ”
Politico, like a number of outlets, pointed out that this is a “shift from language in the Republican replacement bill circulating in the House.” That will surprise Republicans whipping the vote. (CNN noted, “The amendment would allow states to seek waivers to weaken several key Obamacare insurance reforms that protect those with pre-existing conditions, including the benefits insurers must cover in their policies and the ban on allowing carriers to charge more based on a person’s health background.”)
Moreover, Trump suggested that the bill is still changing. This, too, should come as a shock to House Republicans, who thought they reached a final deal last week that gives states the right to opt out of several of the Obamacare protections.
It is not clear if Trump is confused about what is in the bill or thinks the negotiations should continue until his “mandate” (which is the Obamacare mandate, to be clear) is secured. If what he is referring to is the provision that says states can opt out of equal treatment for those with preexisting conditions (so-called community ratings), then the amendment authored by Reps. Mark Meadows, R-N.C., and Tom MacArthur, R-N.J., fails. Their amendment says that states can opt out of the protection for preexisting coverage if they have a so-called high-risk pool. But there is no limit on what those pools can charge, nor is there a federal guarantee of funding. (The bill provides $15 billion but does not say what happens if that money runs out.)
Trump also insists that premiums will go down. (In Trumpcare, many of Trump’s own voters — older and rural Americans — will pay more.) Perhaps if aides put a map in front of him, as they did with the North American Free Trade Agreement (NAFTA), showing how many of his supporters would be adversely affected, he would change his mind.
To be fair, Trump is not the only Republican confused about high-risk pools. House Speaker Paul Ryan, R-Wis., often asserts that high-risk pools are the solution to coverage for individuals with preexisting conditions. Nothing in the experience of these pools suggests that this is the case, however. Kaiser Health News reported last November:
More than half of state high-risk insurance pools have closed in the past few years, according to data from the National Association of State Comprehensive Health Insurance Plans (NASCHIP). In other state-run high-risk pools, new enrollment has stopped and overall participation has dropped, the data showed. Premiums ranged from 125% to 200% of the average individual market rate in a given state, according to NASCHIP… .
“High-risk pools segregate sick people into plans that are more expensive to both the government and the individual,” said Anthony Wright of Health Access, a coalition of consumer advocates.
Wright said the high-risk pools were among the “failures” in the health care system that led to Obamacare.
The experience in California was illustrative. Not only did costs soar, but also gigantic waiting lists formed and the coverage included many limitations that Obamacare currently prohibits (e.g. annual and lifetime limits).
Now if you mandated that the pools could not charge more than the average rate in the state and provided a funding stream to guarantee coverage, that would be a different matter. But it would also be ferociously expensive, and in the language of Obamacare critics, set up a “new entitlement.”
House Republicans and the president do not appear to be on the same page. If Trump “mandates” protection for preexisting conditions and says his bill must lower premiums, the latest bill does not do it. Someone should tell the president — or tell House Republicans to keep negotiating.
Jennifer Rubin is a Washington Post columnist.