House Republicans seem to be trying to outdo themselves. The latest amendment to the American Health Care Act, the GOP’s so-called Obamacare “repeal and replace” plan, makes a terrible bill much worse. In its current form, the bill would allow states to waive key consumer protections established by the Affordable Care Act, endangering their citizens’ health. This is dangerously misguided. By giving states automatic waiver approval to dilute these key consumer protections, the GOP is letting right-wing governors make life-and-death decisions for their constituents just to score political points.
The new amendment to the GOP House bill allows states to opt-out of core provisions of the Affordable Care Act that have given millions of Americans the peace of mind and security insurance should provide. Specifically, the bill would allow states to choose to ignore the requirement that health insurance covers a set of essential benefits, including maternity coverage. States could also return to the days when sick people could be charged more than healthy people for their coverage. While the president may claim, “I want it to be good for sick people,” it simply is not. This bill would result in millions of Americans with preexisting conditions seeing their premiums increase, and many would lose their health coverage altogether, particularly in red states that take up this new Trumpcare option.
“Governors who opt for Trumpcare will burden their citizens with worse coverage and higher premiums for those who dare to get sick...”
Unfortunately, we’ve seen this movie before. Five years ago, the Supreme Court made it possible for extreme right wing governors to deny coverage to the poorest people in their states, by deeming that the Medicaid expansion outlined in the ACA was voluntary for states. During my time as a senior Obama Administration official in charge of supporting states’ implementation of the ACA, I saw firsthand the impact of this decision. It didn’t end well. Allowing states to choose whether or not to cover low-income individuals through Medicaid created a coverage gap for the poorest individuals in non-expansion states. To this day, 19 holdout states and their (mostly) Republican governors, have continued to turn down the generous federal funding provided in the ACA for Medicaid expansion—just to have a very expensive talking point: I rejected Obamacare. That may play well in a CPAC speech, but on the ground, their decisions impact real people’s lives and hurt their states. Studies have shown that people in states that have expanded Medicaid are healthier, have less medical debt, and that the federal funding benefits a state’s economy, bringing in more dollars and jobs and reducing uncompensated care costs.
Coupled with the destructive capping of Medicaid spending included in the initial legislation, allowing states under the AHCA to opt out of the consumer protections that were a key part of the ACA will only serve to exacerbate the disparity in health coverage across blue and red states. Governors who opt for Trumpcare will burden their citizens with worse coverage and higher premiums for those who dare to get sick – if they can afford coverage at all – and leave their state insurance markets in peril. With uncertainty about what state requirements will be, insurers will either dramatically raise rates or pull out of a state’s market altogether. This outcome is in diametric conflict with the President’s promises of falling premiums, more choices, and guaranteed coverage for those with pre-existing conditions.
In an ideal world, governors of both parties would see through this false choice and opt to protect both their constituents and their insurance markets. However, as we saw with Medicaid expansion, that won’t be the case in states led by ideological governors or state legislatures. In the deepest red states that delivered their votes for the president, people better hope they stay healthy, or they may find themselves without any options for their own care. The wellbeing of our fellow Americans should not be a pawn in the politics over healthcare, but that is just the situation the GOP is setting up with their new bill.
