Published: Mon, July 17, 2017
World | By Paul Elliott

Major insurance groups call part of health bill 'unworkable'

Major insurance groups call part of health bill 'unworkable'

Ted Cruz (R-TX), with the support of other conservative senators and outside groups, will be included in the revised Obamacare repeal language being unveiled Thursday, Senate aides confirmed to TPM.

TPM's report also quoted Tim Jost, a health care law expert and professor at Washington and Lee University, saying the Republican "gives an additional $70 billion to the states and then the Cruz amendment gives it to insurers that offer compliant plans in addition to noncompliant plans". These non-compliant plans wouldn't have to cover the "essential health benefits" that Obamacare plans on the exchanges are required to cover, but they'd be a lot cheaper.

"This proposal would fracture and segment insurance markets into separate risk pools and create an unlevel playing field that would lead to widespread adverse selection and unstable health insurance markets", the group America's Health Insurance Plans wrote in a memo.

If you're going to rush a secret plan into law, you really need to be working with an off-the-shelf policy.

Meanwhile, as the ACA-approved plans attract the less healthy, their premiums would rise to unaffordable levels. It's true that insurance premiums have increased under Obamacare, but for most individuals on Obamacare the premiums are still affordable after the subsidy. Rand Paul of Kentucky, who still oppose the BCRA, have praised the Cruz-Lee amendment for giving consumers more coverage choices. If people with pre-existing conditions are the only ones buying policies that have to cover pre-existing conditions, those policies will get pretty expensive - maybe prohibitively expensive. That's a long way from a "market-based" health-care system, but it would definitely be better than the Obamacare status quo-and it would certainly mean more middle-class Americans could afford to buy coverage.

But let's back up.

Prior to choosing a fixed-indemnity insurance plan, it's important you understand what such a health plan entails. This of course is what's happening under Obamacare. Under this legislation, an insurer who had some Obamacare-compliant plans could also craft plans that were, say, great for 30-year-olds with a low risk of cardiovascular disease, but awful for 53-year-olds with high blood pressure and cholesterol, or that simply denied coverage to anyone over age 60 with a history of health problems.

Nor is there any detail in the bill of how these high-risk pools will work.

That brings us to the present day. As premiums rose, younger and healthier people, who didn't think coverage was an absolute necessity, simply didn't buy insurance. But it also throws a bone to moderates, since it doesn't entirely abandon sick Americans to the fangs of the free market.

"We have to look at the whole person", she said. But it was only funded with a one-time appropriation of $5 billion, and enrollment was capped at 115,000 before the exchanges opened because the program was running out of money.

Senate Republicans can lose just two votes and still pass their bill. States lost a collective $1 billion on these bills.

Or how about the 42-year-olds who aren't sick now, but had health scares in the past? It's likely, too, that more people would actually purchase individual market coverage, since the bill would allow tax credits to apply to more types of coverage, like catastrophic and lower-premium plans, and allow people with health savings accounts to use pre-tax dollars to help pay premiums. For those who aren't, there would be the exchanges, which would function like high-risk pools. Nothing for maternity care, mental health or medication? Hence they are often sold as a rider or special amendment to an existing insurance plan, instead of an independent policy. Probably, although there's no way to know for sure until we see such a system in action.

To check what conservatives say is the "unsustainable" growth of Medicaid spending, the GOP bill lowers the rate of traditional Medicaid spending and caps how much is spent on each person.

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