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Reducing reform to ‘guaranteed issue’

July 15, 2019

Topics: Quote of the Day

By Yusra Murad
Morning Consult, July 11, 2019

In a July 8-10 survey of 1,988 registered voters, a 44 percent plurality said it’s unlikely that the lawsuit will be successful in gutting the ACA, compared to 37 percent who see it as a possibility. Faith in the lawsuit’s success rests comfortably along party lines: Democrats aren’t betting on it, with almost 6 in 10 saying the court is unlikely to upend the ACA, while a majority of Republicans (54 percent) say the opposite.

This is not the ACA’s first confrontation with legal challenges, but this time, top lawmakers from both parties have been relatively less animated about the possibility of repeal. Republicans have worked to distance themselves from the case, wary of its implications for millions of Americans with pre-existing conditions and haunted by the 2018 midterm elections, in which dozens of Republicans were unseated over the issue of health care.

Among voters who think the ACA may be gutted, 60 percent are confident the Trump administration has a replacement plan. That includes 87 percent of Republicans.

For months, President Donald Trump has vowed his administration is on the brink of unveiling a health plan fit to replace the ACA. That plan — or any of its details — has yet to be seen.


Republicans make U-turn on health care

By Alexander Bolton
The Hill, July 14, 2019

Senate Republicans are reversing course and now taking a hard look at health care legislation to replace the 2010 Affordable Care Act in case the courts strike down former President Obama’s signature achievement.

There’s a sense of urgency among GOP lawmakers to come up with a plan to replace the most popular components of ObamaCare after a panel of appellate judges on Tuesday aggressively questioned whether the law passes legal muster following Congress’s repeal of the tax penalty for not having insurance.

A nullification in the courts could leave millions of people with pre-existing medical conditions without insurance and disrupt coverage for others.

Just the consideration of legislative action is an about-face from a few months ago when Senate Majority Leader Mitch McConnell (R-Ky.) said Senate Republicans would not move legislation to replace ObamaCare before the 2020 election, arguing it would have no chance of passing Congress, particularly with a Democratic-controlled House.

But on Tuesday, McConnell pledged that the Senate would act swiftly to protect people with pre-existing medical conditions if a GOP-backed lawsuit is successful in overturning ObamaCare.

“I think the important thing for the public to know is there’s nobody in the Senate not in favor of covering pre-existing conditions,” McConnell said.

“We would act quickly on a bipartisan basis to restore” those protections if struck down by the courts, he added.

Sen. Mitt Romney (R-Utah), who as governor of Massachusetts in 2006 implemented a health insurance law that later served as a template for ObamaCare, is taking the lead in negotiations, according to Republican senators who have spoken to him.

Romney is working with Sen. Rick Scott (R-Fla.) and consulting closely with (Sen. Lamar) Alexander (R-Tenn.) and Senate Judiciary Committee Chairman Lindsey Graham (R-S.C.).

Republican lawmakers say they need to be more prepared with ideas to replace ObamaCare than they were in 2017, when a seven-month effort to repeal and place the law failed on the Senate floor in spectacular fashion.

Romney met with Alexander and Graham on Thursday afternoon to discuss what a Republican alternative to ObamaCare would look like, according to a Senate aide familiar with the meeting.

Scott says the goals of the legislation would be to protect people with pre-existing conditions and allow young adults to stay on their parents’ health insurance plan until age 26, two of the Affordable Care Act’s most popular provisions.

“There’s two things that were in ObamaCare — pre-existing conditions and staying on your parents’ plan. We don’t have any idea what’s going to happen in the court case, but what we ought to be doing anyway is trying to figure out how to pass something that covers those two issues,” Scott said.

“A bunch of us have been trying to figure out how to do it,” he said. “We’ve talked to a lot of people.”

Asked how he would pay for any costs associated with protecting people with pre-existing medical conditions and extending health coverage for young people until age 26, Scott asserted the GOP plan will not require a major expenditure.

“It’s not really something to be paid for. It’s something insurance companies have to do, and they’re doing it now,” he said. “They’re all complying with it now.”

“Republicans on this issue of pre-existing conditions can’t have it both ways. You can’t support the lawsuit and say you give a damn about pre-existing conditions,” said Sen. Bob Casey (D-Pa.), a member of the Senate Health Committee. “They have nothing prepared.”

When informed of Romney’s effort to put together a fallback plan to protect people from losing health insurance, Casey said, “They’ve been saying that for at least eight years.”

“This is what happens when the leadership of a political party doesn’t spend much time on health care for 25 years. They come up with loopy ideas,” he said of Scott’s argument that protecting pre-existing conditions would not require significant additional federal spending.



By Don McCanne, M.D.

Compared to the problem that our health care system is performing very poorly in spite of the trillions of dollars we are spending on it, this issue of covering preexisting conditions is almost trivial. Yet for a couple of years the Republicans have fixated on it as their proposal for reform should they be successful in abolishing the Affordable Care Act (ACA), whether through legislation or the courts.

Now that two of three appeals court judges have hinted that the individual mandate may be unconstitutional and not severable from the rest of ACA, the Republicans are facing the prospect that they may have to fulfill their promise of a better option for health care reform. In the last election they said that guaranteeing coverage of preexisting conditions and extending coverage for dependents until age 26 was their proposal for reform, even though those policies were already part of ACA. That feeble proposal did not sell well and the control of the House shifted to the Democrats.

Although Republicans have been pursuing in the courts the revocation of the entirety of ACA, they seem to have waited until the threat that they may be successful in eliminating ACA to begin crafting the replacement proposal. Astonishingly, they have reverted to supporting the same guaranteed issue and dependent coverage proposals.

This time they brought in newly elected Sen. Mitt Romney of Romneycare fame – the basis of ACA. There is no hint that they would repeal ACA (Obamacare) and replace it with Romneycare, so what are they to do? They are now also turning to Sen. Rick Scott, former Columbia/HCA chief executive – a company that paid a $1.7 billion fine for Medicare and Medicaid fraud.

So what is Sen. Scott’s solution? Guaranteed issue and dependent coverage. And how is that to be financed? “It’s not really something to be paid for. It’s something insurance companies have to do.” So they get rid of the individual mandate, pass a measure that makes unaffordable insurance even more expensive, and then give individuals the option of not buying the insurance they can’t afford. Some solution.

So where are the Democrats in all of this? Let’s have Medicare for All but we must leave in place the private insurance plans. High premiums? Unaffordable deductibles? Limited choices within provider networks? Surprise out-of-network bills? Gouging by pharmaceutical firms? A Medicare public option would be only one more in the menu of health plans, having eliminated none of the profound administrative waste that greatly adds to the very high costs of our health care system. Some solution.

The single payer model of an improved Medicare for All would fix this. Yet we do not have a Congress nor a president who are willing to move forward with the requisite legislation. Whose fault is that? How can you draw any other conclusion than the fact that the voters have failed in their responsibility to put democracy in action for the benefit of all? It is disingenuous to simply blame “the other party” for our ills.

Physicians for a National Health Program does not support any political party or candidate for office.

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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