The Washington PostDemocracy Dies in Darkness

Opinion The GOP has a new plan to destroy Obamacare. It’s even crueler than the last one.

Calling Obamacare a "crisis," House Speaker Paul Ryan (R-Wis.) said the GOP is "in the midst of negotiating finishing touches" on their new health-care plan. (Video: Reuters, Photo: JOSHUA ROBERTS/Reuters)


House Republicans have been hinting they may introduce a new plan to replace Obamacare before the 100th day of the Trump presidency. Naturally, giving President Trump something to arbitrarily tout as an achievement (even if it passes the House, the Senate looms) in advance of the arbitrary 100-day mark is far more important than the human toll the proposal would have on millions.

Now Republicans are indeed set to introduce the new plan, multiple reports tell us. And judging by a new study set to be released today, it is even crueler than the last GOP plan: The study finds premiums would likely soar for the sick, probably pushing them off coverage.

The Huffington Post has a detailed rundown of the new GOP plan, which is designed to bridge the gap between moderates and conservatives who rejected the last one for different reasons. It allows states to seek a waiver to get rid of the Affordable Care Act’s prohibition on charging higher premiums to people with preexisting conditions, on the condition that states set up or participate in high-risk pools that would help cover any of those people who lose insurance. It would also restore to the GOP bill the ACA’s requirement that insurers cover Essential Health Benefits (EHBs) — such as doctor’s and emergency room visits and maternity care — but allow states to seek waivers from them.

House Speaker Paul Ryan (R-Wis.) announced an amendment to the GOP health-care plan "to try and find consensus" after an earlier failure to find enough support. (Video: Reuters)

In effect, the waiver on preexisting conditions is designed to make conservatives happy, while giving moderates high-risk pools that allow them to argue it wouldn’t harm people with preexisting conditions. The restoration of EHBs is designed to make moderates happy, while telling conservatives states could still get out from under them.

But the waiver on prohibitions against jacking up premiums for people with preexisting conditions — which is called “community rating” — is a major problem. It would smack them with far more in costs — potentially pushing them off coverage entirely.

The liberal Center for American Progress (CAP) conducted a new study — set to be released later today — on how much these premiums might soar for people with various preexisting ailments. The “surcharge” in the middle column represents additional premium charges that insurers are projected to add to coverage of each condition annually, and the numbers are eye-popping:

Topher Spiro, a health policy analyst at CAP, tells me that these sums were calculated by using actuary “risk scores” for each condition, which detail how much someone with that condition costs insurers relative to a healthy person. (Focus on the first two columns for now; the third will be elucidated by the report itself.)

“If insurers can charge sick people higher premiums than healthy people, they would add a surcharge to premiums that reflects this additional cost,” Spiro says. “The premium markups would be unimaginable, adding thousands or even tens of thousands of dollars to premiums. They would be priced out of the market and quarantined into high-risk pools.”

Now, in fairness, these findings are based on calculated national averages, so applying them to what would happen in any given state is tricky. But this is intended as a general guideline of what sort of premium hikes we might see in states that did seek waivers — and it’s fair to assume many red states would do so. What’s more, this conclusion dovetails with the general conclusions of other health policy analysts. The big story is that, while the new plan would ostensibly keep the prohibition against refusing to cover people with preexisting conditions, allowing premiums to be jacked up would functionally price a lot of those people out of the market, gutting that protection.

Indeed, the nonpartisan Kaiser Family Foundation’s Larry Levitt tells me he thinks the CAP projections are plausible. “These figures show why a guarantee of coverage without community rating offers essentially no protection for people with pre-existing conditions,” Levitt says. “No insurance company will want to cover people with expensive health conditions if they don’t have to, so they will set premiums to make sure the coverage is out of reach. Health care costs are highly concentrated among a small number of people who are sick, and they would find it impossible to get affordable coverage.”

Of course, the new plan’s defenders would reply that these people can go into high-risk pools (this is apparently meant to give moderates cover to back it). But they’ve historically been underfunded and/or resulted in people paying higher prices or going without coverage.

Meanwhile, the new GOP plan would keep in place the old plan’s phase-out of the Medicaid expansion, which would itself result in 14 million fewer people on Medicaid, according to the Congressional Budget Office. You’d think that this, plus the gutting of protections for preexisting conditions, would render the new plan toxic for GOP moderates who, in rejecting the old plan, have confirmed that they are not willing to embrace a massively regressive plan that would push millions of poor and sick people off coverage while delivering an enormous tax cut to the rich. Of course, the need to give Trump a fake achievement to tout is also an urgent matter, so who knows what they’ll do.


* HOW THE FBI GREW INTERESTED IN CARTER PAGE: The New York Times reports that the FBI’s interest in former Trump campaign adviser Carter Page intensified after he gave a pro-Putin speech in Moscow last July and spent days there in meetings:

After Mr. Page … stepped down from the Trump campaign in September, the F.B.I. obtained a warrant from the Foreign Intelligence Surveillance Court allowing the authorities to monitor his communications on the suspicion that he was a Russian agent. From the Russia trip of the once-obscure Mr. Page grew a wide-ranging investigation, now accompanied by two congressional inquiries, that has cast a shadow over the early months of the Trump administration.

Trump allies maintain that his role was minimal, but Page has said his half year on the campaign was very important to him. Either way, law enforcement is taking this very seriously.

* TRUMP SHOULD HURRY UP AND JUST CUT TAXES, SOME SAY: NPR reports that some sympathetic to the Trump administration think he should forget about a broad tax reform overhaul for now and just quickly cut taxes to rack up a win. One former Trump adviser, NPR notes, has been hearing from investors and businesses who “say they’re getting nervous that Trump’s tax cut may not happen.”

No Obamacare repeal … no tax cut … what a tragic outcome that would be!

* KAREN HANDEL’S VULNERABILITIES: CNN profiles Karen Handel, who is now the GOP candidate in the June runoff against Jon Ossoff in the closely watched House special election. Two key points:

[Her] stances on social issues are certain to be a focus in the runoff — particularly her effort to stop the Susan G. Komen Foundation, the breast cancer charity where she was senior vice president for policy, from funding screenings through Planned Parenthood because she opposes abortion rights … Handel’s efforts as secretary of state to purge Georgia’s voter rolls by requiring voters to prove their citizenship led to fights with the Justice Department’s Civil Rights Division.

The first could draw more attention when the budget fights over Planned Parenthood cuts pushed by the GOP heat up. The second could help goose Democratic turnout.

* DEMOCRATS LAUNCH HUGE AD BLITZ IN GEORGIA: The Atlanta Journal-Constitution reports that Democrats have already unleashed a massive barrage of ads hitting Handel:

The Democratic Congressional Campaign Committee put $450,000 behind an ad that slams Handel as “just another career politician” and questioned her use of public funds while she was Georgia’s secretary of state. And Ossoff’s campaign, restocked with more than $500,000 in donations after Tuesday’s vote, also said it will resume a barrage of ads propping up the former congressional aide on Thursday.

That half a million is a sign of continued Democratic energy — the question is whether voters will come out for him a second time. Meanwhile, a GOP group is airing a spot tying Ossoff to Nancy Pelosi.

* TRUMP’S FIRST 100 DAYS WERE HISTORICALLY #SAD: Trump says that no president has accomplished more in his first 90 days than Trump has. Glenn Kessler takes a detailed look at the claim and finds that it’s nonsense. As one political scientist puts it:

“Trump actually is unusual for his first 100 days, but for a reason opposite of what he said. Not only has he accomplished almost nothing, but rather his initiatives (executive orders stayed by courts, a major legislative proposal failing even to come to a vote when his party controls both houses, etc.) have notoriously been unsuccessful.”

Don’t worry, Mr. President, you are breaking new historical ground.

* KEEP THE FOCUS ON TRUMP’S AUTOCRACY: E.J. Dionne Jr. has a nice column on Trump’s conduct in office and runs through the list of questions that it raises:

Should Trump separate himself completely from his business interests, as presidents had been doing for more than four decades?…Should he release his income-tax returns so the public can see where conflicts might exist — including whether he will benefit from his own tax proposals?… Should he continue former president Barack Obama’s practice of making the White House visitor logs public so all can know who might be influencing his policies?

As Dionne notes, Trump’s implicit answer to all of these is: No, I can do what I want. And in this lies not only the potential for corruption but also an autocratic assumption that he is above normal expectations.