Freedom. It’s what the Freedom Caucus is all about, their name suggests. And the Freedom Caucus is the group that made its voice heard, the group of Congress members that forced changes to the Trumpcare bill that would, in their minds, enhance our freedoms as Americans. But they’ve got a funny definition of freedom. Funny as in the kind of gut-busting joke that, well, actually would tear your stomach apart.
Trumpcare 2.0 centers on the destruction of one of the core elements of the Affordable Care Act—the guarantee that, no matter what pre-existing health conditions you’ve got, you won’t be denied coverage and you won’t face price discrimination either. If Trump and his fellow Republicans get their way, you’ll be “free” from the peace of mind that comes with those protections.
Those stricken with cancer or other expensive illnesses—which not infrequently led to bankruptcy in the pre-Obamacare days—will now be able to bask in the glow of their new freedoms. Please note that personal bankruptcies have been cut in half since 2010, with the ACA playing “a major role” according to a wide array of health care experts interviewed by the independent watchdog Consumer Reports. And since anyone of us could be struck by such a devastating disease at any time, this means we will all benefit from Trumpcare’s new freedoms on pre-existing conditions.
Here’s exactly what the measures that won over the Freedom Caucus would change:
States could apply for a waiver to opt out of Obamacare’s rule that prohibits health insurers from charging sick people more than healthy people. So insurance for people with preexisting conditions might technically still be on the market, but premiums could be so high that many of those people couldn’t afford it. That’s the big problem for many moderates (and therefore House leaders).
[Speaker Paul] Ryan’s release says states would have to argue the change would, for example, lower premiums in order to get the waiver approved. The bill itself, though, makes approval effectively automatic unless the federal government stops it.
States would also be required to set up a high-risk pool, where sick people could buy coverage, in exchange for a waiver. But the historic problem for high-risk pools has been that they didn’t have enough money to cover sick people, and Larry Levitt at the Kaiser Family Foundation told me the AHCA has the same problem. The money included in the bill is also less than what conservatives have projected is necessary for high-risk pools to work.
People could also not be discriminated against if they maintained health coverage, another defense deployed by the bill’s defenders. But if you do let your insurance slip, you’re out of luck. So that still isn’t the same level of protection that Obamacare offers.
Additionally, those Americans with lady parts will enjoy an extra dose of freedom with Trumpcare. Sarah Spellings explained that postpartum depression and Caesarian sections (only women get those last time I checked) along with surviving rape and domestic violence (women predominate there as well) all fall under the category of pre-existing conditions. Insurance companies will also have the freedom to choose not to pay for mammograms and gynecological care. As our own Laura Clawson put it, “Trumpcare will again make being a woman a pre-existing condition.”
On a related note, remember when two different Republican members of Congress, one male and one female, both questioned why men should have to pay for maternity care they’d never need? With Trumpcare, they may not have to anymore, as health insurance companies will now be freed from the previous requirement that all plans cover certain essential benefits, one of which is maternity care. Do you recognize a pattern in terms of who would be gaining more freedom under Trumpcare?
Going beyond maternity care, here’s the loathsome Joe Walsh, a former Republican member of Congress, in response to Jimmy Kimmel’s impassioned argument regarding the need to maintain the protections for those with pre-existing conditions: “your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.”
Walsh’s Twitter handle is “Walsh Freedom.” He too associates himself with that word, i.e., the freedom from having to pay for someone else’s health care. It’s also worth noting that he sought the freedom from having to pay child support—that means for his own kids, not “somebody else’s.” More seriously, Democrats understand that one of the most important freedoms is freedom from fear, in this case the fear of not being able to afford life-saving medical care. Obamacare’s guarantees have had a lasting, positive impact on that front.
Walsh typifies Republicans who, as he claimed, are all about “logic and reason” when it comes to health care. In reality, Obamacare’s rules represent the height of logic—it makes perfect sense for everyone to share the risk of a financially disastrous injury or illness, but doing so only works if the federal government mandates and regulates how that sharing will work. This is the same principle behind Social Security, which protects against poverty in old age.
More broadly, this conservative push to destroy the guarantees for people with pre-existing conditions—all in the name of freedom—exemplifies the difference between Republicans and Democrats. For all their flaws, Democrats sit down and ask themselves: what’s the best way to solve a given problem?
On this issue, they saw that insurance companies were denying coverage to people with pre-existing conditions, so they banned that practice. In return, so that the insurance companies wouldn’t have a huge added expense with no benefit, Democrats created the individual mandate and other measures to bring healthier people into the insurance market and create a substantial cost for those who would otherwise try to ride free by not getting coverage—which they were guaranteed if they could make it until the next enrollment period—until they needed it. It was a common sense solution to an important problem that worked within the context of a broader bill that, if imperfect, has significantly improved health coverage and thus access to care for millions of Americans.
Republicans, or at least the overwhelming majority of them, approach just about any issue from the same series of ideological premises: federal government = bad, regulation = bad. Then they ask: how can we reduce those things as much as possible, irrespective of whether doing so would actually solve the problem at hand—or make it worse.