OPED: Trump is going after preexisting condition protections

Jon Healey
Los Angeles Times
This Tuesday, Oct. 23, 2018 photo shows website on a computer screen in New York. The sign-up period for next year’s individual health insurance coverage runs from Nov. 1 to Dec. 15. Picking a plan can initially involve several trips to websites like just to understand the options. Shoppers who want to stick with the same plan must scrutinize it for changes. (AP Photo/Patrick Sison)

It’s almost as if the midterm election escaped the notice of the U.S. Department of Health and Human Services.

As you may recall, voters decisively bounced Republicans from control of the House. Democrats had spotlighted Republicans’ attacks on Obamacare, and more specifically the GOP’s efforts to end the law’s protections for millions of people with preexisting conditions. (Those protections apply to the roughly 15 million people who buy insurance directly because they’re not covered by health plans at work; a different federal law provides similar protection to people covered by large group plans.)

Yet here we are, a little more than three weeks from the election, with a new gambit by HHS to promote cheaper, thinner insurance policies — at the expense of people who need comprehensive coverage. You know, like people with preexisting conditions.

The document issued Thursday by HHS’ Centers for Medicare and Medicaid Services offers four alternative approaches to Obamacare that states might take under a rule CMS issued last month. One would allow states to design their own plans for distributing federal premium subsidies for low- and moderate-income households, rather than following the income limits and subsidy percentages set by Congress. A second would direct such subsidies into health savings accounts, encouraging consumers to sign up for high-deductible policies. A third would allow states to provide subsidies to health plans that don’t comply with Obamacare’s requirements, including the one requiring policies to offer comprehensive coverage. A fourth would let states shunt people with high healthcare costs (read: preexisting conditions) into the sort of high-risk pools that many states used prior to Obamacare.

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“Nothing in the new guidance or the waiver concepts changes the requirements for health insurance issuers to provide protections for people with preexisting conditions,” the administration stated in Thursday’s release. And that’s true to a point — insurers would still be required to offer coverage to people regardless of their health histories, and not to factor a person’s preexisting conditions into his or her premiums.

But a key piece of the Obamacare approach was to gather everyone in the individual market into big regional pools and comprehensive health plans so that risks and costs could be spread broadly. To varying degrees, each of these approaches the administration touted Thursday could be used to split those pools into more and less risky groups, encouraging younger, healthier people to abandon comprehensive coverage and concentrating more of the cost of those plans onto the people who need them.

That’s a feature of the administration’s approach, not a bug. Granted, Obamacare’s insurance reforms are hardly the only way to ensure that people with preexisting conditions have access to the coverage they need at rates they can afford. (And it wasn’t especially good on the affordability front.) But we’ve already seen what happens when states create high-risk pools: The cost of the premium subsidies eventually grows so large, states limit enrollment and roll back coverage, exposing a growing number of people to the risk of ruinous medical bills.

Innovative state approaches to curbing healthcare costs and making comprehensive insurance more affordable would be welcome. The administration’s proposal, however, seems geared more toward providing thinner, cheaper plans to people who least need coverage.