The House Republican “moderates” are holding up the Trump-Ryan healthcare bill over an issue that seems substantial, but is really trivial. This whole bill is being held up by a concern that some — not even most but some — of a pool of about 309 people per Congressional District might find it hard to get insurance.
The conservatives have proposed — and Trump seems to have adopted — two steps that will bring down premiums sharply: One, that states should be able to let insurance companies write policies that exclude one or more of the “essential” services Obamacare requires them to include. (Policies that cover these services fully will still be available for those that want them). Two, again with Trump’s agreement, states would be able to abandon “community rating” in setting premiums. This change will let insurers price plans based on the age and health of the beneficiary, something Obamacare allows only within a very restricted band.
Both measures will bring basic, catastrophic insurance premiums way down and make them affordable, particularly for young couples just starting out. But “moderates” worry that the older (55-65) and sicker among the covered population will find the resulting premiums too high and unaffordable.
So Trump-Ryan have responded to these concerns by offering to let states set up high risk pools of sicker and older patients where higher premiums could be charged, with greater public subsidy. But “moderates” worry that the pool’s policies may be unaffordable.
And that is where the bill stands right now.
But…the actual population about whom the moderates are worrying is not large.
ObamaCare, too, had a high-risk pool provision and, like the GOP “moderates”, the program’s sponsors vastly overestimated the number of people that would need it. It was called Pre-Existing Insurance Plan (PCIP) and was expected to cover 375,000 people at a cost of $5 billion.
But after four years of operation (until it was cancelled in 2014) only 134,708 people entered the pool. Did the rest find premiums outside it affordable? Most likely did. For those who did not, we can adjust the legislation after it is passed to deal with the problem. It’s not worth scuttling the entire bill. Bear in mind that only about 5,000 people accounted for half of the money required.
So, come on. Don’t hold up the new legislation over this detail. Use regulations to fix any problems that come up.
Put this whole issue in perspective: Fixing ObamaCare is the broken-down vehicle in the traffic lane that is causing the gridlock. It makes Trump look bad and his administration incompetent. It will cost us dearly in the midterm elections unless we get an ObamaCare reform and repeal passed.
Moderate and conservative Republicans: It is in your political interest and in the national interest that you compromise. It may not be perfection, but the Ryan-Trump bill is pretty damn good.
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