Version 2 of Senate GOP Trumpcare Out: Pre-Existing Condition Discrimination Is Back

[paralleluniverse]

The big change is insurers can sell non ACA-compliant plans as long as they sell at least one ACA-compliant plan.

This will turn the exchange into a high-risk pool. The healthy people will buy cheap plans that cover very little, and get screwed when they get sick. The sick people will get screwed because they will need ACA-mandated benefits and can be outright rejected from the other plans, but such plans will have totally insane costs because only other sick people will buy these plans and they will be completely unaffordable for millions of people.

So discrimination based on pre-existing conditions is fully back.

The Medicaid cuts that are worse than wiping out the Medicaid expansions remain.

More details here.

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Update: 14 July 2017
The GOP deception is real: the CBO score next week WILL NOT include the Cruz Amendment which brings back discrimination based on pre-existing conditions. They will use the Trump-controlled HHS to score it.

This means the CBO score will NOT be of the actual disastrous and deadly bill they will vote on.

Here's an analysis of the Cruz Amendment, blasted by even the insurance lobby, America’s Health Insurance Plans:

Allowing Health Insurance Products Governed by Different Rules and Standards Would Further De-Stabilize the Individual Market and Increase Costs for Those With Pre-Existing Conditions

Policies that increase uncertainty or threaten instability should be avoided

Background: Reports have surfaced that potential changes to the proposed Better Care Reconciliation Act (BCRA) in the Senate are being considered that could permit health insurers to sell non-compliant plans if the health insurer offered at least one plan in a state’s federally-regulated Exchange Marketplaces (“Exchange”). Under this proposal, the non-compliant policies would be exempt from consumer protections, such as guaranteed access to coverage, community rating (e.g. no, premium surcharges based on health-status), the ban on pre-existing condition exclusions, and the requirement to offer comprehensive benefits with appropriate limits on patient cost-sharing.

Stable and well-functioning insurance markets require broad-based enrollment and a stable regulatory environment that facilitates fair competition and a level playing field. Unfortunately, this proposal would fracture and segment insurance markets into separate risk pools and create an un-level playing field that would lead to widespread adverse selection and unstable health insurance markets. This is particularly true for patients with pre-existing conditions—who would be most affected and potentially lose access to comprehensive coverage and/or have plans that were far more expensive, as premiums in the Exchange market would rise much faster than under existing market conditions and insurance options dwindle.

• Opening up non-compliant plans to new purchasers would create greater instability in the marketplace, according to non-partisan experts such as the American Academy of Actuaries. A key contributing factor to the current risk pool instability in certain states was the transitional policy, which allowed individuals to renew non-compliant plans. That is because it segments the market—allowing healthier individuals to remain in their existing medically-underwritten plans while depriving the new Exchange markets of younger and/or healthier individuals necessary for risk pool stability. Actuaries estimated that states adopting the transitional policy experienced 10% higher rates for the Exchange market than states that did not elect this policy. Proposals to re-open non-compliant plans would create even greater instability by driving adverse selection and an acceleration of the downward spiral in the Exchange markets of higher premiums and lower enrollment.

• The requirement that insurers also participate in the Exchange market would not preserve protections for those with higher-than-average health care costs. Such protections—such as guaranteed issue, community rating, and banning pre-existing conditions—only work if there is broad participation to assure stable markets and affordable premiums. By bifurcating risk pools and creating separate parallel market—where healthy individuals can select underwritten plans at a preferred rate—this proposal would cause lower enrollment in Exchange markets of the younger and heathier individuals necessary for a stable insurance market. As a result, the Exchange markets would basically function like a high-risk pool—with unaffordable premiums for those with pre-existing conditions. As premiums rose, only those with the highest health needs and expenses would remain thereby accelerating the decline in the Exchange market.

• Including both “compliant” and “non-compliant” plans in a single risk pool would be infeasible and not solve the problems of an unlevel playing field. For a single risk pool to work, all health plans must provide coverage for the same benefit categories – for example, under a common federal benefit “floor.” However, if “skinnier” non-compliant plans could exclude coverage of certain benefit categories (e.g., prescription drugs or maternity) while compliant plans must cover all benefit categories, it would be very challenging to combine those products into a single risk pool. Moreover, important premium stabilization programs such as risk adjustment that compensate plans enrolling higher risk individuals and protect against adverse selection would become unworkable and unsustainable because of likely differences in the benefit categories, health status and costs of enrollees in compliant versus non-compliant plans.

Conclusion: The individual market faces well-documented challenges to stability, including higher premiums, lower-than-expected enrollment, fewer plan choices, and risk pool problems in certain states and markets. Policy solutions exist to create more stability in the market by reducing premiums and attracting enrollment of younger and healthier individuals. In this context, it is important that policymakers avoid policies that threaten to further increase uncertainty or threaten stability. Such policies include opening up non-compliant plans to new enrollees, bifurcating the risk pool, or allowing plans covered by different rules to compete in the same market.

Source: https://morningconsult.com/wp-conten...07.10.2017.pdf

Here's an analysis of the Cruz Amemdent from the Kiaser Family Foundation:

As the Senate considers the Better Care Reconciliation Act (BCRA), a proposal to repeal and replace the Affordable Care Act (ACA), amendments have been discussed to further change private health insurance market rules that apply under current law. Under the BCRA, current law health insurance market rules would still apply: Insurers in the non-group health insurance market are prohibited from turning applicants down or charging higher premiums based on health status and from excluding coverage for pre-existing conditions. In addition, all policies must provide major medical coverage for 10 categories of essential health benefits and must limit the annual out-of-pocket cost sharing (deductibles, co-pays and coinsurance) that people must pay for covered services in network (although states can alter those requirements through waivers).

However, an amendment to the BCRA, suggested by Senator Ted Cruz (R-TX), reportedly would allow insurers in the non-group market to also sell some policies that would not be required to follow all of the ACA market rules. For example, such policies might not have to follow ACA essential health benefit and cost sharing standards. In addition, some reports suggest that insurers would not have to sell these policies to people with health conditions or risks and could vary premiums for them based on the health of applicants.

This brief examines the likely impact of such a change on the stability of coverage offered through non-group markets and on the number of individuals who might be affected.
Impact on Consumers Ineligible for Premium Subsidies

If the BCRA were amended to permit insurers to sell ACA-compliant plans alongside plans that did not follow ACA-benefit standards and/or rating and access rules, the likely result would be that the cost of ACA-compliant plans would skyrocket. The ACA-compliant plans would effectively become a high-risk pool, attracting enrollees when they need costly health benefits – such as maternity care, or drugs to treat cancer or HIV, or therapies to treat mental health and substance abuse disorders – and those with pre-existing conditions who are turned down by non-compliant plans or charged high premiums based on their health. By contrast, non-compliant plans would attract healthier consumers, at least as long as they didn’t need coverage for such benefits. Premiums from the healthier enrollees would not be pooled to help keep the price of compliant plans affordable. As a result, premiums for compliant plans would increase significantly, while premiums for non-compliant plans would be substantially lower (though they would also cover fewer benefits).

The Senate BCRA would continue ACA-like premium tax credits to subsidize the cost of coverage for low-and middle-income individuals. Like the ACA, premium tax credits under the BCRA would be tied to the cost of a benchmark marketplace plan, though the benchmark would have higher patient cost-sharing than under the ACA. Eligibility for premium tax credits would be capped at income of 350% of the federal poverty level (FPL), compared to 400% FPL under current law. Individuals eligible for tax credits would be required to pay a set percentage of their annual income toward a benchmark plan; the premium tax credit amount for each individual would be the difference between the actual cost of the benchmark plan and a person’s required contribution. Under this formula, as under current law, subsidy-eligible people would generally be shielded from annual premium cost increases, which would instead be absorbed by federal premium tax credits.

While people with pre-existing conditions eligible for premium tax credits would be cushioned from premium increases in compliant plans under the Cruz amendment, those ineligible for credits would not be protected.

According to the National Health Interview Survey, approximately 40% of non-group market participants in 2015, or 6.1 million people, had income above 350% FPL. Most of these individuals purchased non-group coverage outside of the marketplace. Under the BCRA, these individuals would not be eligible for premium tax credits.

We further estimate that, among the 6.1 million non-group market participants with incomes of at least 350% FPL, 24% (or about 1.5 million) would have pre-existing conditions that would have been considered automatically deniable by insurers prior to the ACA. These conditions include cancer, diabetes, HIV/AIDS, hepatitis, substance use disorders (including opioid addiction), serious mental illnesses, and pregnancy.


Figure 1: Non-group Health Insurance Market Participants with Income of at Least 350% FPL Who Had Declinable Pre-existing Conditions, 2015

For these 1.5 million individuals, non-compliant plans would likely either deny coverage outright or charge very high premiums tied to their health. Even if they could obtain coverage in non-compliant plans, it might not cover key benefits, such as maternity care, mental health care, substance use treatment, or prescription drugs, and would not solve the affordability problem.

Among the three-quarters of other market participants with income over 350% FPL, millions would have other types of pre-existing conditions that were not considered automatically declinable prior to ACA, such as high-blood pressure, high cholesterol, asthma, and depression. Many in this group also could see a substantial increase in out-of-pocket spending for medical care that would offset any premium savings associated with less comprehensive policies.

Source: http://www.kff.org/health-reform/iss...-health-plans/

[Edge-]

So the "Cruz Amendment" made it in, I see.

The one that even health insurance companies don't want because it's going to create a de-facto "high risk" pool for anyone who actually needs health insurance, and the dirt-cheap pool of plans for healthy folks who want worthless catastrophic insurance.

Republicans continue to place a very low monetary value on human life once a baby is born, especially if you happen to have the misfortune of being poor, sick, injured, or old. They don't actually want to improve the system and protect Americans, they just want to cut costs, specifically for the wealthy.

[Gestopft]

GoP: digging a grave for themselves, American people, or both?

But hey, instead of improving coverage or reducing cost, let's just go back to selling turds as insurance.

[Daelak]

The big change is insurers can sell non ACA-compliant plans as long as they sell at least one ACA-compliant plan.

This will turn the exchange into a high-risk pool. The healthy people will buy cheap plans that cover very little, and get screwed when they get sick. The sick people will get screwed because they will need ACA-mandated benefits, but such plans will have totally insane costs because only sick people will buy these plans and they will be completely unaffordable for millions of people.

So discrimination based on pre-existing conditions is fully back.

The Medicaid cuts that will be worse than wiping out the Medicaid expansions remain.

More details here.

Reads like republicans still don't know how to govern, just pursue their donors interests and the neo-confederate ideological purity tests.

[Xeones]

This works for the republicans. They "keep the system as is" but it's turned into a high risk pool, they can just ignore that and yell later on "See how expensive it is! It totally failed!" while ignoring that it was their fault it failed.

But you know, at least you'll be able to pay for insurance that doesn't cover anything with their plan again!

[Eliandal]

Read it this afternoon, and boy...all I can say is...Sorry Americans


Collins has already come out and said she's a no. Two more and you guys are safe , for now anyways :/

[cubby]

It's beyond amazing how the GOP seems so intent on killing americans and/or fucking up our healthcare system. MAGA!

[Zan15]

So the "Cruz Amendment" made it in, I see.

The one that even health insurance companies don't want because it's going to create a de-facto "high risk" pool for anyone who actually needs health insurance, and the dirt-cheap pool of plans for healthy folks who want worthless catastrophic insurance.

Republicans continue to place a very low monetary value on human life once a baby is born, especially if you happen to have the misfortune of being poor, sick, injured, or old. They don't actually want to improve the system and protect Americans, they just want to cut costs, specifically for the wealthy.

Yup cruz does not understand how insurance works, even after all this time

[Edge-]

Yup cruz does not understand how insurance works, even after all this time

I think he does, he just places an extremely low value on human life, especially if you happen to be poor, sick, or old.

[Belize]

It's beyond amazing how the GOP seems so intent on killing americans and/or fucking up our healthcare system. MAGA!

They just want their tax cut.

Then they can trickle down over less wealthy americans.

[burzian]

What a truly reprehensible piece of legislation. Hopefully it alienates enough sensible republicans to die the brutal death it deserves.

[Wyrt]

They could just go out and shoot people if they want to kill people that badly.

[Edge-]

They could just go out and shoot people if they want to kill people that badly.

Line them all up on 5th Avenue and let Trump shoot them. I mean, he said he wouldn't lose any voters, right? : P

[Paranoid Android]

This or some bill is going to pass.

I liked they put in a few of taxes an ACA amendments to fudge the books for better CBO score. So it will look good on the books for a few years then go away.

[Toppy]

Its going to take decades to work the GOP and their followers out of the American political system.

This is just disgusting, but, people will support it. Because the GOP is a cult.

[mage21]

So discrimination based on pre-existing conditions is fully back.

If I had 47 car accidents in the last week and State Farm refuses to insure my vehicle, is that discrimination based on pre-existing events?

[Wyrt]

If I had 47 car accidents in the last week and State Farm refuses to insure my vehicle, is that discrimination based on pre-existing events?

This is a retarded example.

Someone born with type 1 diabetes isn't at fault for their pre-existing condition. Why should they be punished for something they can't control?

[mage21]

This is a retarded example.

Someone born with type 1 diabetes isn't at fault for their pre-existing condition. Why should they be punished for something they can't control?

So the determining factor here is whether the person had any control over the circumstance? Got it, just trying keep up.

[Toppy]

So the determining factor here is whether the person had any control over the circumstance? Got it, just trying keep up.

That's always been the issue. If you're just now catching up, you were years behind.

[Xeones]

Yup cruz does not understand how insurance works, even after all this time

You give him way too much credit. He understands, he just doesn't care. You have a preexisting condition? "Fuck you I got mine" is his motto.