W

ASHINGTON — 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.

advertisement

THE CLAIMS:

“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 FACTS:

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.

THE CLAIM:

“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

THE FACTS:

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

Leave a Comment

Please enter your name.
Please enter a comment.

  • I was 39 years old when I left an employer of nearly 20 years. As a single parent, I needed less than an 80 hour week, to address the needs of my child. Due to my “preexisting condition” when 90 days of Cobra was over, to continue being insured, I had to pay over $4,000.00 per month for my high risk coverage! I nearly gave up! I was trying to build my own business, take care of aging parents, & not miss a step in grooming my daughter to be someone great ~ someone who would never face the same hardships.
    Then along came Bill Clinton & my rates dropped to about $500.00 per month.
    If I had been uninsured, there’s no chance I’d be alive today & in my 60’s! The high risk pool was cancelled by my insurer due to Clinton’s legislation. He literally saved my life!
    Forced into retirement at ago 50 by disability, I still had a daughter to put through college & law school. Then a fire devastated my home, took my Mother & pets, along with all my possessions. The insurance didn’t pay & I had legal expenses for 3 years trying to recover.
    After the fire, hospitalization & being discharged with absolutely nothing (no clothes, shoes, cars, or access to money), I was given less than 30 days to find new insurance or I was back to $2,700.00 per month, with disability income half that much? How could I focus? I hadn’t even buried my dead? A couple weeks after discharge from the hospital’s ICU, I was hit by a car as a pedestrian (hit & run). Damage to my spine went undetected for several years while I was literally mopping up my life!
    If this Republican bill passes, I’ll likely end up in a state that allows fatal cocktails, because I won’t be able to afford care to save my life! Thank you republicans ~ you are trying to take away my only chance to afford life, grow old & survive!
    I always worked hard & saved. Who knew I’d be forced to live from savings for 15 years before I hit retirement age? Now, the republicans are about to destroy the future I’ve worked so hard to protect! ObamaCare saved me; now what? With this bill, I’m not likely to have much of a future!

    • I read your story. Many people are facing similar situations.
      I have a rare form of NH Lymphoma that is incurable, but manage able. In other words, expensive. If not for Medicaid expansion I would surely be dead. I would not have lived to see my first grandson.
      I’m too young for Medicare, and haven’t been healthy enough for private insurance since I was 25 years old.
      You see, young people get sick and they also get injured. My ex husband had a car wreck when he was 25 and left severely brain damaged. He has had s lifetime of medical issues. No one would insure him at any price! Fortunately he was declared disabled ( words I never thought i would say) so he was able to get Medicaid. But if he is kicked off because he is in Texas nothing would surprise me, he will certainly die.
      I know many people, in fact most people who cannot pay crazy high premiums and high deductibles.
      I guess I’m just letting you know there are so many of us out here and we are scared.
      When I see them talking about the political strategy of this bill I realize how out of touch they are with real people.
      They celebrate as people are bracing themselves for death, pain, discomfort.. some are receiving care for mental illness that will end. Panic attack sufferers like myself will be house bound unable to pay for psych visits and medication.
      I have three illnesses two of which hit me in my 20’s neither of them brought on by ” lifestyle” and I’m so upset.
      I have no answers and I’m completely defeated. Godspeed.

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine.