Actions Speak Louder Than Words

Action

I was going to do a political update this week, go over some of the proposals 2020 candidates have been putting forward, but today the Trump administration finally revealed their true intentions for healthcare. House Speaker Nancy Pelosi promptly countered with the announcement of a bill aimed at fixing loopholes in the ACA that are hurting Americans.

Before today, the Justice Department, which answers to the Executive Branch (the President), had made it a policy not to defend the ACA in court. This prompted 20 state attorneys general to claim that the law is unconstitutional. But today, the Trump administration went from passive approval of the case to active support of the lawsuit.

See, the ACA was first challenged just two years after it passed. Republicans claimed it was unconstitutional then because the individual mandate (penalty for not having insurance) fell outside the Commerce and Necessary and Proper Clause, which gives Congress the power to regulate commerce. But Chief Justice John Roberts, who ended up being the swing vote, upheld the ACA’s constitutionality on the grounds that the penalty was actually a tax, and as such, Congress had the right to impose it.

Now, since the Trump tax cut that is basically screwing everyone including Trump voters repealed the individual mandate, the justification for protecting the law is gone. In the new case, a federal judge in Texas ruled that 1) constitutional rights are being harmed by being forced to buy health insurance (odd, since that provision no longer exists), and 2) that severance (separation of the individual mandate from the rest of the law) did not apply. The judge said that Congress wouldn’t want any of the law to stand without the individual mandate, even though that’s exactly what’s been happening for the last 15 months.

For now, nothing major is going to happen. Everything will stay the same while the case goes through the federal appeals process and up to the Supreme Court.

 If it succeeds, these are the mandated benefits we will lose:

  • Pediatric services, including oral and vision care;

  • Mental health and substance use disorder services, including behavioral health treatment;

  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices;

  • Prescription drugs;

  • Ambulatory patient services (outpatient services);

  • Emergency services;

  • Hospitalization;

  • Maternity and newborn care;

  • Laboratory services, and finally

  • Preventive and wellness services and chronic disease management (this is the benefit that means insurance can’t deny, delay, or inflate prices for those with pre-existing conditions)

In addition, we would lose the provision allowing children to stay on their parents’ insurance until they’re 26 and the lifetime cap that keeps us from going bankrupt from medical bills. And all 37 of those states that voted for Medicaid expansion? That will be rolled back, too. Remember, these are the people (including Trump) who swore up and down during the last election cycle that they would protect those of us that have pre-existing conditions, even while they supported the lawsuit and voted over and over and over to repeal the ACA.

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Reaction

Hours later, House Speaker Nancy Pelosi held a press conference announcing the Protecting Pre-existing Conditions and Making Health Care More Affordable Act, an attempt to address the areas where people are feeling the most pain from the ACA. The timing was not an accident.

The new bill was introduced in the press conference by four members of the freshman class, including Lauren Underwood (IL-14), who is both a provider and has a chronic heart condition, and with the support of the chairs of all three committees that have jurisdiction over healthcare: Energy and Commerce, Education and Labor, and Ways and Means (Budget does, too, but it’s a different part of the process).

The bill includes provisions that:

  • Expand the eligibility for the tax breaks that help balance the costs of ACA premiums. This will help the families who make too much to qualify for the tax breaks now, but don’t make enough for high premiums to not to harm the household.

  • Increase the tax credits for everyone.

  • Create a reinsurance plan (insurance for insurers) to help cover high cost patients (like me!) instead of resorting to high risk pools, which make costs super low for healthy people, but group all the high-cost patients together so that costs only rise instead of being defrayed over a large, diverse population.

  • Offer funding incentives for states to create their own marketplaces (CA, CO, CT, DC, ID, MD, MA, MN, NY, RI, VT, and WA already have their own).

  • Reverse the ruling by the Trump administration allowing short-term and association plans, which are not compliant with the ACA and deceptively slim on what they do cover.

I found it very interesting that, while we debate the merits of much farther-reaching healthcare plans (Medicare for all, Medicare buy-in, single payer, etc.), this House is offering concrete policy solutions that would shore up what we already have. In its original form, the ACA would have been much more comprehensive than how it ended up. Instead, the ACA, which was based on Republican Mitt Romney’s Massachusetts plan, and which borrowed heavily from policy written by the Heritage Foundation (an organization so conservative that won’t walk past the front door for fear of getting hit by lightning), was slowly picked apart by its detractors.

Admittedly, the proposed bill is very unlikely to pass the Senate, but if you consider healthcare your most important issue, and you are trying to figure out which proposed healthcare solutions are the best and whose plan is actually going to address your concerns, remember that actions like introducing bills and developing detailed policy proposals speak louder than words, especially words that are spoken to cover actions of the past.