WASHINGTON — They promised you a rose garden.
This past week, President Trump and Republicans legislators celebrated passage of a House bill seeking to replace the Affordable Care Act. At a White House event, they heaped praise on their effort and brushed off worries that health coverage could be imperiled for many people if the Senate goes along with the legislation.
Here, we break down the claims and the facts.
“We’re going to unshackle, build an economy, let people have greater choice in their health care and protect pre-existing conditions.” — Representative Kevin McCarthy, House majority leader, at the Rose Garden celebration Thursday marking passage of the House bill
“There are so many things, multiple, multiple layers in our bill that we passed today that not only protect people with preexisting conditions, but actually focus real targeted money on lowering premiums for families with preexisting conditions.” — Representative Steve Scalise, House majority whip, Rose Garden event
“We cover [preexisting conditions] beautifully…. And I mandate it. I said, ‘Has to be.'” — President Trump, CBS interview. April 30
The history of high-risk pools and broad expert opinion call all of this optimism into doubt.
In certain circumstances, people with an existing illness would face the prospect of dramatically higher premiums than other people pay, despite protections in the bill and the addition of $8 billion over five years to help states cover those with high medical costs.
People with medical conditions may need this help if they have a lapse in coverage. Under the Republican bill, states could get waivers that allow insurers to charge higher premiums to those customers, but only if they have a gap in coverage and if the state has a mechanism such as a high-risk pool to support them. Robert Graboyes, a senior research fellow at the conservative Mercatus Center, called the $8 billion “a pittance.”
Lapses in coverage could become more common if the Republican bill delivers less financial support than President Barack Obama’s law does for people buying individual insurance coverage.
“Many people with pre-existing conditions will have a hard time maintaining coverage because it just won’t be affordable,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation.
In the more than 30 states that had high-risk pools before Obama’s health care law took full effect in 2011, net losses piled up to more than $1.2 billion, with losses averaging $5,500 per person enrolled.
“If you simply look at the facts, more people took the penalty or the exemption than actually signed up for Obamacare.” — McCarthy, Rose Garden event
That’s a fair comparison, if not the full picture. It leaves out Medicaid expansion.
The law expanded coverage primarily by giving millions more people Medicaid, setting up the subsidized markets for individual coverage and letting adult children stay on their parents’ plans until they turn 26. Altogether, those measures cover more people than the number who claimed exemptions from the mandate to obtain health insurance or who paid a penalty for lacking insurance.
But McCarthy, R-Calif., is right when comparing the roughly 12 million enrollees in the individual market with the 19.5 million who did not sign up for the coverage because they couldn’t afford it or didn’t want it.
Last year, nearly 13 million people claimed exemptions from the mandate to obtain health insurance, citing financial hardship or other reasons, and 6.5 million paid the penalty for lacking insurance (averaging $470) rather than choose a marketplace.
Counting both the subsidized market and the Medicaid expansion, Obama’s law provides coverage for some 20 million people.
The Republican bill that passed the House would end the extra federal payments 31 states are accepting to expand Medicaid to more people. It would also replace Obama’s federal subsidies for lower-income insurance buyers with age-based tax credits.
— Calvin Woodward and Jim Drinkard with Paul Wiseman, Josh Boak, Alicia A. Caldwell, Lolita C. Baldor, and Tom Murphy