Trump administration wants to get rid of protections for pre-existing conditions

Let’s see the Trump administration’s latest attempt to help the average American:

The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirement that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions.

Both President Trump and leading Republicans have said they support protections for people with pre-existing conditions, but this was done with his knowledge:

Attorney General Jeff Sessions said in a letter to Congress on Thursday that Trump, who campaigned on repealing the law and nearly did so his first year in office, approved the legal strategy.

And it  affects a huge number of people:

It confirms that a large fraction of non-elderly Americans have pre-existing health conditions: at least 23 percent of Americans (61 million people) using a narrow definition based on eligibility criteria for pre-ACA state high-risk pools, or as many as 51 percent (133 million people) using a broader definition closer to the underwriting criteria used by insurers prior to the ACA.

Between 2010 and 2014, when the ACA’s major health insurance reforms first took effect, the share of Americans with pre-existing conditions who went uninsured all year fell by 22 percent, meaning 3.6 million fewer people went uninsured.

And the effect is pretty bad:

a 2009 survey found that, among adults who had individual market coverage or shopped for it in the previous three years, 36 percent were denied coverage, charged more, or had exclusions placed on their policy due to pre-existing conditions. A report by the Government Accountability Office estimated that, as of early 2010, the denial rate among individual market applications was 19 percent, and the most common reason for denial was health status.

It’s part of a long term strategy (notice the post is from February):

Already in recent weeks, the Trump administration has shown little interest in enforcing Obamacare’s guarantee that healthy and sick people get access to the same type of health insurance.

For example, it hasn’t intervened in Idaho, where regulators recently told insurers they can simply disregard many of the Affordable Care Act rules and sell new “freedom plans” that discriminate against sicker enrollees.

The rules the Trump administration rolled out Tuesday relate to “short-term” health plans, coverage that is meant to fill gaps between more permanent policies (for someone who takes a few months off between jobs, for example).

Short-term coverage is allowed to skirt several of the health care law’s core provisions: Plans can deny people insurance based on their medical history, charge them higher premiums because of their preexisting medical conditions, and craft skimpy benefits packages that will appeal mostly to young and healthy people.

So, as usual, Trump claims he’s trying to help people as he makes things much worse for them.

Insurance companies and Medical Providers join forces to increase healthcare costs

It would seem that insurance companies and hospitals would be adversaries since, you would think, insurance companies want to pay the hospitals as little as possible. It seems that’s not true:

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

And, of course, this means the typical patient gets screwed:

But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That’s more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.

Fuming, Frank reached for the phone. He couldn’t see how NYU Langone could justify these fees. And what was Aetna doing? As his insurer, wasn’t its duty to represent him, its “member”? So why had it agreed to pay a grossly inflated rate, one that stuck him with a $7,088 bill for his portion?

It’s not just out of pocket expenses:

Economist Priyanka Anand of George Mason University said employers nationwide are passing rising health care costs on to their workers by asking them to absorb a larger share of higher premiums. Anand studied Bureau of Labor Statistics data and found that every time health care costs rose by a dollar, an employee’s overall compensation got cut by 52 cents.

The reason they can do this is it’s almost impossible to get the actual cost of medicine beforehand:

Patients who want to know what they’ll be paying — let alone shop around for the best deal — usually don’t have a chance. Before Frank’s hip operation he asked NYU Langone for an estimate. It told him to call Aetna, which referred him back to the hospital. He never did get a price.

This is starting to be solved by sites such as Healthcare Bluebook and state laws mandating medical cost transparency. Hospitals and others are pushing back, such as filing a lawsuit in Ohio to stop the implementation of a transparency law or they often ignore a law such as one passed in Massachusetts.

 

3=3.49

Via here, we get this:

Insurers would have more leeway to vary prices by age, so that premiums for the oldest customers could be 3.49 times as large as those for younger customers. Today, premiums for the old can be only three times as high as premiums for the young, which is what the Affordable Care Act stipulates. According to sources privy to HHS discussions with insurers, officials would argue that since 3.49 “rounds down” to three, the change would still comply with the statute.

At some level, this is politically stupid since it explicitly raises the rates of older people while reducing it for the young–the opposite of the voting pattern for Trump. For me, the problem is the math–at most 3 times as large means at most 3 times as large, even 3.01 is out, never mind 3.1 or 3.49.

This will be similar to the “Pi Bill” from Indiana which indirectly says that pi is 3.2 (the bill tried to prove a method of squaring the circle, which is impossible, by making it a law).

This is the type of thing which shows why there needs to be a March for Science (it will be on April 22 with satellite marches all over the country).

Obamacare works

The Census Bureau has a report out on the number of uninsured in the US in 2013 and 2014. Let’s see the conclusions:

The percentage of people without health insurance coverage decreased sharply between 2013 and 2014 by just under 3.0 percentage points, specifically, by 2.9 percentage points as measured by the CPS ASEC. The ACS measured a comparable decline. The CPS ASEC uninsured rate, which represents the percentage of the population who had no health insurance coverage during the entire year, changed from 13.3 percent in 2013 to 10.4 percent in 2014.

After several years of a relatively stable uninsured rate between 2008 and 2013, as measured by the ACS, the percentage of the population who were uninsured dropped between
2013 and 2014, marking the largest percentage-point decline in the uninsured rate during this period

Let’s put that in context:

In 2014, 10.4 percent of people (or 33.0 million) were uninsured for the entire calendar year. This was a decrease of 2.9 percentage points from 2013, when 13.3 percent (or 41.8 million) were uninsured for the entire calendar year.

Hmm, I wonder how widespread it was?

Between 2013 and 2014, every state and the District of Columbia experienced a decrease in their uninsured rate

People of all education levels experienced an increase in the rate of health insurance coverage between 2013 and 2014.

Between 2013 and 2014, health insurance coverage rates increased for each income category.

Between 2013 and 2014, the population living at every income-to-poverty ratio level experienced a decrease in their uninsured rate.

Between 2013 and 2014, all of the family status groups experienced an increase in health insurance coverage rates.

Between 2013 and 2014, health insurance coverage rates increased for all nativity groups.

Between 2013 and 2014, the overall rate of health insurance coverage increased for all race and Hispanic-origin groups.

The percentage of people without health insurance coverage dropped for every single age under 65 between 2013 and 2014

It sure does seem that it helped pretty much all groups of people. I wonder how the states that resisted it did:

Variation in both the uninsured rate and change in the uninsured rate by state may be related to whether the state expanded Medicaid eligibility in 2014 as part of the Affordable Care Act. In general, in 2014, the uninsured rate in states that expanded Medicaid eligibility was lower than in states that did not expand eligibility. In states that expanded Medicaid eligibility (“expansion states”), the uninsured rate in 2014 was 9.8 percent, compared with 13.5 percent in states that did not expand Medicaid eligibility (“nonexpansion states”).

The decrease in the uninsured rate was 3.4 percentage points in expansion states, compared with 2.3 percentage points in non-expansion states.

That’s good work there by the Republican governors–their states, on average, had a higher percent of residents without health insurance before the expansion AND their states decreased the rate of those without insurance less. If the non-expansion states had reduced the uninsured rate as much as the expansion states (and their reduction should have been larger since they started with a higher rated of uninsured) then that would mean the rate would have decreased by 3.4% overall which means about 1.5 million more Americans would have insurance.

Hey, that’s a great slogan for the Republicans–“we kept 1.5 million Americans from getting health insurance”.

On the other hand, maybe Republicans don’t want to trumpet this which may be why Obamacare has barely been mentioned in the first two Republican debates.

Contraception

A government panel has recommended that contraception now be available without a copay:

Virtually all health insurance plans could soon be required to offer female patients free coverage of prescription birth control, breast-pump rentals, counseling for domestic violence, and annual wellness exams and HIV tests as a result of recommendations released yesterday by an independent advisory panel of health specialists.

Hopefully it’s progress that they couldn’t get a politician to object, just the crazies (I’m probably wrong, it’s early after all):

Jeanne Monahan, director of the Center for Human Dignity at the socially conservative Family Research Council, said that many Americans may object to birth control on religious grounds. “They should not be forced to have to pay into insurance plans that violate their consciences,’’ she said. “Their conscience rights should be protected.’’

Just as troubling, Monahan said, was inclusion of emergency contraceptives such as the so-called morning-after pill sold as Plan B and the more recently approved drug sold as Ella. Both work primarily by inhibiting ovaries from producing eggs. But abortion  opponents argue that there is evidence the drugs can also prevent a fertilized egg from implanting in the womb, which they consider equivalent to abortion.

and:

President Barack Obama’s health care law already requires most health plans to provide standard preventive care for people of both sexes at no additional charge to patients. Women’s health recommendations were considered new and politically sensitive territory, so the nonpartisan institute was asked to examine the issue.

Nonetheless, a fight over social mores is brewing. Catholic bishops and other religious and social conservatives say pregnancy is a healthy condition and the government should not require insurance coverage of drugs and other methods that prevent it. (Most health plans already cover contraception.)

The conservative Family Research Council said the recommendations could lead to a federal “mandate” for abortion coverage, since emergency contraceptives such as Plan B and Ella would be covered. But the Food and Drug Administration classifies those drugs as birth control, not abortion pills. Panel member Alina Salganicoff, women’s health policy director for the Kaiser Family Foundation, said abortion drugs are not included in the recommendations.

One of the reasons politicians try to stay away from the anti-contraception people is that contraception is very popular:

For instance, Sonfield said, a Guttmacher study found that 98 percent of sexually active Catholic women and nearly 100 percent of evangelicals have used contraception at some point, compared  with 99 percent of women overall.

In any case, this is a good step.

US government requires me to own a house

I find these type of ideas a bit funny:

Attorneys general in 14 states have filed suit against the health care legislation on grounds that it is unconstitutional. While the claims vary, a chief argument is that there is nothing in the Constitution that allows the government to require individuals to purchase anything. Lawsuits are also likely to be filed by insurance companies and individuals.

The way the individual mandate will be enforced is with tax penalties. If people have a problem with this, let me propose rephrasing it. Let’s say that we will increase everyone’s taxes and give a rebate to anyone who has health insurance. Notice that this is exactly what is done with several other items, including mortgages for houses (which Republicans don’t seem to have a problem with). Since I rent, that means that I get a tax penalty–in effect I’m subsidizing all of you who own a house and have a mortgage.  Also, according to the language used here, there is a mandate to take out a mortgage to buy a house.

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