Under the ACA, insurers are required to offer comprehensive health plans to everyone and charge them the same price regardless of whether they have a pre-existing condition. They can charge smokers more than non-smokers and older people up to three times as much as young people, but they aren't allowed to take other health factors into account.The proposal the White House is floating would change all that.
Exactly one month ago tomorrow, House Republicans formally unveiled their long-awaited health care plan, along with an online Q&A about the proposal's alleged virtues. The site asked, "Are you repealing patient protections, including for people with pre-existing conditions?"Answering their own question, Republicans replied, "No. Americans should never be denied coverage or charged more because of a pre-existing condition."Of course, a lot has happened over the last month. House Speaker Paul Ryan was forced to change his "American Health Care Act" in the face of opposition from within his own party, and then change it again. The entire initiative failed spectacularly, though the Republican drive to repeal the Affordable Care Act didn't disappear.And so, GOP leaders continued to plot and scheme, looking for ways to alter the party's plan to satisfy the demands of various party factions, most notably the far-right House Freedom Caucus. NBC News' Benjy Sarlin reported yesterday on the latest iteration, which takes aim at the protections for those with pre-existing condition -- the same protections Republicans vowed to keep.
To be sure, the emerging compromise -- what many are calling "Zombie Trumpcare," because it's back from the dead -- doesn't yet exist in written form. Closed-door negotiations have been ongoing, but the talks haven't led to specific legislative text that we can scrutinize in detail.But we know enough to recognize that Republicans are weighing a new plan that's vastly worse than its wildly unpopular original plan.The new, emerging version includes all of the elements the American mainstream already opposed -- taking coverage from tens of millions of people, slashing Medicaid, handing big tax cuts to the wealth -- adds the elimination of essential health benefits, including maternity care, and then tops it off by scrapping the "community rating" provision of the ACA.In practical terms, while "Obamacare" prevents insurers from charging the sick more for insurance than the healthy, the new-and-not-improved Republican plan would scrap the protection.Some GOP officials have pushed back against this interpretation, saying Americans with pre-existing conditions would still be able to buy private coverage, but there's no reason to take this seriously. If you were born with a heart condition, and your insurer says, "We'll cover your heart-related ailments for $1 million," you've effectively had your health security taken away.The Republican plan, in other words, was already offensive, but they're now in the process of adding "Let's stick it to sick people even more" provisions. GOP officials are moving in this direction, not because they think it'll be an effective or successful plan, but because they see it as the only way to get a bill that would pass the House.When polling showed 17% of Americans embracing the original Republican plan, I assumed these guys couldn't have come up with legislation less popular than the AHCA. Now, I stand corrected -- because the public would hate this version even more.The public need not panic, however, about the bill's prospects. The same intra-party divisions that derailed the Republican health care plan last month remain unresolved, and it's hard to imagine the circumstances in which this bill passed the Senate.But it speaks volumes about the GOP's priorities and direction that the party won't let its health care crusade go, even if it makes making a bad bill worse.