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Kicking a dead mule – how the new AHCA fails

Why anyone would attempt to revive a health care reform bill that sank into the waters of the Potomac just weeks ago is a puzzler.

Why they would revive it and attempt to pass it by making it potentially even less popular is more puzzling still.

Yet that’s where we find ourselves, as the House Freedom Caucus, led by Rep. Mark Meadows, NC-11, who appears to have caved to Washington’s pressure for a dramatic “win.” Now, repealing the patient protections in the Affordable Care Act has been something of a great white whale to idealogic Captain Ahabs since the day it was passed. The House voted over 60 times to repeal the ACA’s protections, with Representatives knowing they wouldn’t be held accountable to voters stripped of those critical protections. The actuality of replace-and-repeal coming to pass likely wound up residing in the public conscience alongside the prospect of the Cubs winning the World Series.

But the Cubs proved capable last year of taking a different playing field, and it’s a different playing field in Washington with complete GOP control of government. President Trump was looking long and hard for a legislative victory to cap his first 100 days, and ACA repeal topped the list of possible deals.

The first effort wound up being politically toxic to the point it never made it to the House floor for a vote. Its failure wasn’t surprising. For example, most voters age 55-64 who bought health insurance on the individual market would have seen out-of-pocket shares of healthcare premiums spike about $5,800 a year in western NC. The plan also held the potential of 24 million Americans losing their health care coverage.

Although the details are a moving target, the gist of the new and improved American Health Care Act appears to carry little in the way of new and zero in the way of improved. Key language worked on at least in part by Meadows and Rep. Tom MacArthur tweaks the AHCA to allow states to seek waivers to remove the patient protections, allowing insurance companies to reject customers who have pre-existing conditions such as cancer, asthma, high blood pressure, or even pregnancy. For those contemplating genetic testing, insurance companies potentially could even use genetic disposition to deny coverage.

In turn, states requesting the waivers would be required to implement protections to curb cost hikes for those with pre-existing conditions – for example, high risk pools. An AARP Public Policy Institute (PPI) study shows the results of states taking a dip in high risk pools, and the results aren’t encouraging.

The PPI report shows premiums as much as 200 percent higher than those offered in the market, featured waiting periods of as much as a year to cover related or preexisting conditions, yearly deductibles up to $25,000 and annual coverage limits as low as $75,000, not to mention lifetime caps on coverage and restrictions on some specific benefits like prescription drug coverage.

Given the onerous restrictions, it’s understandable some people put off or skipped care, with predictable adverse results.

But even with the high premiums, the state programs covered on average only a little more than half of program costs and operating at a loss wasn’t uncommon. Efforts to make up shortfalls with strategies like assessments on insurers financing from general revenue funds fell short, and as a result, states often had to look to capping or closing enrollment. By the close of 2011 the state pools enrolled less than a quarter-million people, or as PPI notes, 0.6 percent of the total uninsured population in the states that had turned to pools.

It’s important to stress that the temporary high-risk pools under the Affordable Care Act fared poorly as well. The free market has failed to solve the affordability problem for those with pre-existing conditions, as has the states, as has the federal government.

On the political front, Meadows rightly stood firm last month and is in about as safe as seat as there is in the country. Now, however, he appears to have caved, and loyal voters who have to buy the new AHCA’s insurance will pay the price.

Still, a quote used by Senate GOP Leader Mitch McConnell back in 2013 comes to mind: “There’s no education in the second kick of a mule.’’

ACHA 2.0 could carry such a kick for politicians.

But far more importantly, there’s little doubt of the kick it would deliver constituents. It’s an education we can do without.

By Jim Buchanan, AARP North Carolina

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