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On pre-existing protections, watch what the GOP does (not what it says)

To hear Republicans tell it, they're on board with the ACA's protections for Americans with pre-existing conditions. Their actions tell a different story.
A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare in Miami, Fla in 2015. (Photo by Joe Raedle/Getty)
A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare in Miami, Fla in 2015.

To hear Republican officials and candidates tell it, they're fully on board with the Affordable Care Act's protections for Americans with pre-existing conditions. Donald Trump, in particular, has insisted at every recent campaign rally that he and his party should be seen as champions of progressive health care safeguards.

By any sane measure, the argument is indefensible. Not only have these GOP politicians spent years trying to tear them down, they're also championing a lawsuit that would strip millions of families of the protections Republicans now pretend to support.

But as we were reminded yesterday, that's not what they're doing. The New York Times reported:

The Trump administration announced a new policy on Monday making it easier for states to circumvent coverage requirements and consumer protections in the Affordable Care Act.States could, for example, use federal funds to subsidize short-term insurance plans with skimpy benefits and fewer protections for people with pre-existing conditions.Coming two weeks before Election Day, the new policy appeared to be a political gift to Democrats, who are making health care a potent campaign theme.

As is usually the case, the details get a little complicated, but at issue are the ACA "1332 waivers," which allow states to implement their own reforms, each of which must meet minimum standards established under "Obamacare."

These new developments have the effect of encouraging states to exploit the policy and, as a Vox report put it, "set up their own alternatives to the health care law."

The HuffPost's Jonathan Cohn added that the newly announced rule change "almost certainly means that, overall, people with serious medical problems are likely to have a harder time finding coverage -- and, ultimately, paying their medical bills."

Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, told Cohn, "This new guidance allows states to set up parallel insurance markets that may be able to attract healthy people with plans that have lower premiums but fewer consumer protections, leaving ACA plans with a sicker pool and higher premiums."

As a policy matter, the result is a weaker system that's most likely to hurt -- you guessed it -- those with pre-existing conditions.

But as a political matter, the announcement from the Department of Health and Human Services, two weeks before the congressional midterm elections, offers Democrats a cudgel with which to beat Republicans. Indeed, Trump and his team just handed Dems a new talking point: if you ignore what Republicans say and focus on what they do, you'll see they're taking dramatic steps to hurt the Americans they claim to support.

And when Democrats make this argument, it will have the added benefit of being true.