When the occupier of the Oval Office says "all Republicans support people with preexisting conditions" he's lying. To be honest, at least every other public pronouncement he makes is a lie, but this one is particularly huge. And it's particularly not good right now, at least not for Republicans. Because today, 15 days before a midterm election in which health care is the primary motivating factor for voters, the Trump administration is taking further action to allow health plans that don't cover sick people by giving states more leeway to promote the skimpy plans the administration has approved.
Health and Human Services Secretary Alex Azar announced the new proposal saying that states would have a "clearer sense of how they can take the lead on making available more insurance options." While it retains the Affordable Care Act's protections that bar insurers from denying coverage to people with pre-existing conditions, it would significantly reshape those rules, giving states more flexibility in waiving them away.
Kaiser Family Foundation vice president Larry Levitt calls it what it is—a Republican end-run around Obamacare since they "failed at repealing and replacing the ACA last year." The "new guidance gives states the flexibility to do much of it themselves," he says. "The door is now wide open for states to do an end run around the ACA by creating a parallel market with lower premiums but fewer protections for people with preexisting conditions."
The ACA did allow for states to apply for waivers under the law to give them more flexibility in how they structured their markets, giving them the opportunity to do things like experiment with single payer or public options. But under the law, states could not decrease the number of people covered by the comprehensive, ACA-compliant plans with all the essential benefits and promise that they would be covered in any eventuality. That was the "guardrail" Congress created to make sure that people wouldn't be tricked into lesser coverage and that the Obamacare markets would remain stable.
Now Trump is exploiting that flexibility to allow states to shift people out of the ACA-compliant coverage and into the cheap Association Health plans (AHP) and expanded short-term, limited-duration insurance (STLDI) plans Trump has approved. AHPs, under the Trump definition, allow individuals and small businesses to band together to form plans that don't have to offer full benefits. The second expands the three-month short term plans under the law, intended for people who need stop-gap, skimpy coverage as a bridge, to be continued for as long as three years. These plans don't have to offer the full benefits of the ACA, and with this new guidance from the administration, states can promote them without fear that they'll lose any federal Obamacare funding.
Every Republican governor now has a choice—live up to the rhetoric their party is now parroting about protecting people with pre-existing conditions or do what they've intended to all along. Which is to destroy Obamacare by any means possible, no matter the consequences for their constituents.
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