Saturday, July 22, 2017

What Donald Trump does not know about health insurance can hurt you

Trump trips over his own ignorance on health care reports Steve Benen (MSNBC/MaddowBlog).

During the public portion of yesterday’s White House meeting, Trump made a series of bizarre claims about his party’s proposal, making clear that he had absolutely no idea what he was talking point. He said the Republican proposal would offer “better coverage for low-income Americans” than the Affordable Care Act, which isn’t even close to being true. Trump added that the GOP plan is “more generous than Obamacare,” which is bonkers.

Towards the end of his public remarks, the president added, “Your premiums will be down 60 and 70 percent. People don’t know that. Nobody hears it. Nobody talks about it.” In reality, people don’t know that or talk about it because it’s spectacularly untrue.

In the New York Times interview that soon followed, Trump offered this gem:

“So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan. Here’s something where you walk up and say, ‘I want my insurance.’ It’s a very tough deal, but it is something that we’re doing a good job of.”

Huh?

In context, it’s not at all clear that the president understands the difference between health insurance and life insurance. Or put another way, Trump isn’t just confused about the plan he’s eager to sign into law, he’s also confused about the concept of coverage in general.

Yesterday morning, Vox’s Ezra Klein wrote, “*The core problem is Trump has no idea what he’s talking about on health care and never bothered to learn*…. When Trump does weigh in, it’s often a disaster.”

The president then spent the day proving Ezra right.

So where does health care legislation stand?

BusinessInsider.com reports that Senate Republicans [held] an emergency meeting to revive their healthcare bill — but it already sounds like a mess.

According to reports, GOP senators who opposed the first two versions of the Better Care Reconciliation Act (BCRA) will hold a meeting Wednesday night in an attempt to hash out their differences on the plan.

The first two versions of the bill were opposed by both conservative and moderate members. Moderates thought the bill’s cuts to Medicaid and the potential for massive coverage losses under the BCRA went too far. Conservatives felt the bill did not go far enough in its rollback of the Affordable Care Act’s regulatory structure.

Senate Majority Leader Mitch McConnell has attempted to bring the two sides to a compromise but has faced two rounds of defections that have killed different versions of the legislation.

Given this state of play, McConnell told reporters after a Senate GOP conference meeting at the White House that he would move forward with a key procedural vote to begin debate on the bill sometime next week.

Four Republican senators have said they would oppose such a motion on the latest version of the BCRA, effectively killing it Monday.

At the same time, Sen. John Cornyn — the second-highest ranking Republican in the Senate — said leadership may bring more than just the BCRA to the floor. If that does not work, Cornyn said, the Senate could vote on a repeal-only bill.

“We’re discussing that,” Cornyn said when asked if the BCRA would make a comeback. “I’m more optimistic that that would be the case. But if there’s no agreement, then we’ll still vote on the motion to proceed but it’ll be to the 2015 just-repeal bill.”

If the Senate passes a repeal-only bill, then Trump will have his chance to let Obamacare fail thus inflicting harm on millions of Americans. How might he do that? Here is an analysis by FiveThirtyEight in their TrumpBeat email.

… it’s not clear whether the Trump administration will enforce the mandate that most people have health insurance or pay a fine, though it has already weakened it, which could mean fewer healthy people participating in the marketplaces and higher premiums for those who do. Another is that we don’t know whether President Trump will use marketing and advertising to promote enrollment as the Obama administration did, which has been shown to increase enrollment among healthier people. There are already signs he will not: The Daily Beast reported that the Department of Health and Human Services has been using money earmarked to promote enrollment to create videos attacking Obamacare. And Politico reported that the department canceled contracts with two companies that were supposed to help enroll people during the open enrollment period for next year. Again, fewer healthier people in the marketplaces results in higher premiums.

The other big outstanding question is how Trump and Congress will deal with payments owed to health insurance companies. Insurers are required to give the poorest enrollees discounts on things like deductibles and co-pays; the law intended for the federal government to reimburse those discounts — with Congress appropriating the funds. When Congress refused to do so, Obama made the payments anyway, and Congress sued his administration. (The court case is ongoing.) Trump has been making the payments on a month-by-month basis while threatening to pull them, using the payments as leverage in the ongoing repeal debate in Congress. More than half of people using the marketplaces receive these payments; if insurers aren’t reimbursed, it will push up premiums and could lead some to leave the marketplace.

McConnell and Senate followers are willing to put repeal-only to the vote this coming week. Trump threatens “We’ll just let Obamacare fail.” With those our leaders entrusted with the well-being of American citizens, what could possibly go wrong?

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