Republican health insurance plan isn’t short on problems

Anyone who’s spent any time studying health care knows — as President Donald Trump now knows — the issue is incredibly complicated.

And though it’s unclear what all’s in the final Republican Health Care Plan (RHCP), here’s the problem with some of its proposals.

Policies are complicated. Many people don’t know the details of their homeowner’s, car or health insurance policies. Much of the RHCP is based on the (correct) belief that most people won’t know the details of their health insurance plans. People would only know they’re getting a cheaper policy. They wouldn’t know it doesn’t cover many things. Obamacare mandates that all policies cover essential services like doctor visits, emergency room visits, hospitalization, prescription drugs and lab services. The RHCP would let states eliminate those mandates. Imagine buying a cheap policy, going to the ER, and finding out your insurance won’t cover the visit.

Less for care, more for tax cut. The RHCP would reduce taxes to fund health care by $883 billion dollars over 10 years, and reduce price supports to purchase affordable insurance by $400 billion. Taking almost $1.3 trillion dollars from health care means an estimated 24 million fewer people would be covered, while paying higher costs.

Selling insurance across state lines. One purported panacea would let people buy cheaper plans from other states. Sounds great. Doesn’t work. A Florida resident can’t buy insurance from a Wyoming insurer, for example, if that insurer doesn’t have a Florida network of doctors and hospitals. And if the Wyoming policy is cheaper, it probably lacks certain benefits required in Florida policies. The consumer wouldn’t know about these restrictions. Also, if you’ve got a complaint, good luck in complaining to the Wyoming Insurance Commissioner.

Pre-existing conditions. Say goodbye to this coverage. The RHCP would let states waive coverage for pre-existing conditions or place such people in a “high-risk pool” that charges far higher rates. Does anyone doubt the Florida Legislature, which refused to accept billions of dollars in federal Medicaid money, would waive pre-existing conditions? Which leads to…

High-risk pools. A complete disaster. They don’t work. You can’t purchase health insurance if you’re already ill, unless there’s a mandate that everyone be covered to spread the risk, which is what Obamacare did. The last time Florida had a high-risk insurance pool, rates were 200-250 percent higher than comparable plans, deductibles ranged from $1,000-$10,000, co-pays had no maximum annual limits, the lifetime maximum payout was $500,000 and the policy would not cover pre-existing conditions for 12 months. Even with these limits, the plan required substantial state funding.

Seniors. This bill is a triple-whammy for older Floridians. It eliminates the subsidies that reduce the cost of policies, replacing them with tax credits. The tax credit for someone 60 years old would be far smaller than the Obamacare subsidy. And RHCP allows insurers to charge seniors five times more than what’s charged younger policyholders, up from three times under current law. The bill also cuts $880 billion from Medicaid and in Florida, over 63 percent of Medicaid goes to seniors and the disabled. Medicaid is the largest source of nursing home payments in Florida. What will happen to seniors in nursing homes with a massive cut to Medicaid? “Block grants” will not offset the massive reduction.

Isn’t Obamacare failing, given rising premiums? No, and if it does fail, blame Republican sabotage. One reason for rising insurance rates is the elimination of “risk corridors,” payments meant to help insurance companies that had under-priced insurance premiums. Yes, premiums have increased under Obamacare, but at a lower rate than before. Obamacare has actually reduced health care expenditures in several ways. And if you include the subsidies, the average payment for one of the most commonly used plans decreased between 2014 and 2017. Obamacare is unpopular with some people because of the campaign to demonize it. The Affordable Care Act, the real name of Obamacare, polls much more favorably.

In summary, the RHCP would cut almost $1.3 trillion from the health care system, reduce insured Americans by 24 million people, likely eliminate coverage for pre-existing conditions in Florida, increase premiums for older Floridians and hurt poor seniors who need nursing home care. It’s a bad idea.

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