Republicans Continue to Undermine Pre-Existing Condition Coverage

Missouri Republican Senate candidate Josh Hawley apparently has taken the Hypocrite's oath.

America continues to have the most costly and inefficient health care systems in the world.  It literally costs multiples of what other nations with national systems are paying and it costs lives because many who need health care cannot afford it.  If Republicans have their way, health care insurance will become even more expensive and those with pre-existing conditions may find themselves un-insurable.  This from the party that claims to uphold "Christian values" even as it seeks to slash social programs to cut a deficit cause by a massive tax cut give away for the extremely wealthy and large corporations which have not reinvested their huge windfall in increased employee wages or massive capital investments.  It's little wonder Millennials are walking away from the GOP - and religion. A column in the New York Times exposes the Republican hypocrisy.  If you care about health care, vote Democrat in every race on November 6, 2018.  Here are column excerpts:

On graduation, most medical students swear some version of the ancient Hippocratic oath — a promise to act morally in their role as physicians.

When it comes to how political figures deal with health care, however, we’ve come to expect the opposite, at least on one side of the aisle.  It often seems as if Republican politicians have secretly sworn a Hypocrite’s oath — a promise to mislead voters to the best of their ability, to claim to support the very protections for the sick they’re actively working to undermine.

To see what I mean, consider the case of Josh Hawley of Missouri, who is running for the Senate against Claire McCaskill.

Hawley is one of 20 state attorneys general who have brought a lawsuit attempting to repeal a key provision of the Affordable Care Act — the provision that protects people with pre-existing medical conditions, by requiring that insurance companies cover everyone of similar age at the same rate regardless of medical history. Kill that provision, and millions of vulnerable Americans will lose their insurance.

But here’s the thing: Protecting coverage for pre-existing conditions is overwhelmingly popular, commanding majority support even among Republicans. And McCaskill has been hammering Hawley over his role in that lawsuit.

So Hawley has responded with ads claiming that he, too, wants to protect those with pre-existing conditions, as supposedly shown by his support for a bill that purports to provide such protection.

I have to say, you almost have to admire the sheer brazenness of the dishonesty here. For the bill Hawley touts is a fraud: It’s full of loopholes allowing insurers to discriminate in ways that would end up making essential health care unaffordable for those who need it most. For example, while it would require that they offer insurance to, say, cancer patients, it would allow them to sell policies that don’t cover cancer treatment — which would mean that policies that did cover such treatment would become prohibitively expensive.

And the fraudulence of this bill aside, even serious, nonfraudulent regulation of insurance companies isn’t enough in itself to provide affordable coverage for pre-existing conditions.

That was New York’s experience: Before the A.C.A., it had strong regulations on insurers, but high premiums meant that only people with health problems bought insurance on the individual market (as opposed to getting it from their employers), and this in turn kept premiums high.

To make regulation work, you have to back it up with incentives for healthy people to sign up, including subsidies that help lower-income families afford insurance. In other words, if you really want to make essential care available for pre-existing conditions while continuing to rely on private insurance companies, you need a system that looks a lot like … Obamacare. Indeed, New York premiums dropped in half when the A.C.A. went into effect.

Hence the Hypocrite’s oath. Republicans hate the idea of guaranteeing that all Americans receive essential health care, and they really, really hate the taxes on high incomes that help pay for Obamacare subsidies. And you can imagine an alternative political universe in which the G.O.P. openly admitted its true goals, justifying them on the basis of economic freedom, or something.

But in this universe, Republicans have decided that they must conceal their intention of taking health care away from those who need it most. So they’re doing what Hawley is doing: resorting to a combination of sabotage and smoke screen. On one side, they’re hacking away at the edges of the Affordable Care Act in the hope that it will implode. On the other, they’re pretending to want the very things — like guaranteed coverage of pre-existing conditions — they’re trying to destroy.

[T]his is why many Democrats are talking about Medicare for all. Obamacare was a market-friendly health insurance reform designed in part to mollify conservatives; their response was scorched-earth opposition, followed by a series of attempts to exploit public confusion about how the Affordable Care Act works and what it will take to sustain it. So there’s something to be said for a simpler system that would be harder to game politically.

[P]olls show that Democrats hold a large edge over Republicans on the question of which party people trust more on health care. But that gap would surely be even bigger if more voters realized what the G.O.P. is actually trying to do.

So let’s be clear about this: If you or anyone you care about suffers from a pre-existing medical condition, Republicans are trying to take away your insurance. If they claim otherwise, they’re lying.

I truly believe the rise of deliberate and blatant dishonesty of the GOP directly tracks with the rise of Christofascists in the party base and party bureaucracy.  No one is more dishonest.

What Trumpcare Could Mean for Rural America - Is Southwest Virginia Listening?

Having been involved in Virginia politics for decades one thing that has always been striking is how rural areas of the state - especially Southwest Virginia - regularly votes against their own economic interests.  Appeals to Christian extremism and racism time and time again cause the rural areas to support Republicans who are great at promoting dog whistle racism and swearing fealty to the Christofascists at The Family Foundation but who do nothing to help the failing economy in these areas.  Making matters worse, the downward spiral in reactionary social norms make the areas less and less attractive for modern, progressive businesses to consider locating to the regions.  Now, with Republicans set to either repeal the Affordable Health Care Act or sabotage it further, rural America is on the verge of reaping what it has sown.  A piece at Vox looks at Tennessee as a case study of what may be coming to these Trump/GOP supporting areas of the country.  It isn't pretty and it is self-inflicted.  Here are excerpts:

Tennessee is a preview of what an Obamacare collapse could look under President Trump, where the law technically remains standing but people don’t have access to the programs.

The areas most at risk for this type of collapse are those that voted for Trump: places that are lower-income and rural, which aren’t attractive markets to health insurance companies.

These are places that have struggled to attract robust insurance competition both before and after the health care law’s implementation. “In general, rural areas have always been the places where it’s hard to attract a competitive insurance market,” says Aditi Sen, an assistant professor at the Johns Hopkins Bloomberg School of Public Health who has studied the health law marketplaces. “The incentives to enter just aren’t that strong.”

The Obama administration worked hard to recruit health insurers to sell to those areas. The Trump administration, however, seems to want to stand aside and let Obamacare run on autopilot, so it can explode or survive on its own.

In eastern Tennessee, that could have the practical effect of leaving 40,000 current Obamacare enrollees without coverage.

The stretch of eastern Tennessee where no insurers want to sell coverage includes 6,700 square miles of rolling Appalachian hills and rural roadside towns. It has 16 counties and 1.1 million residents.

Rural areas have long struggled to attract robust health insurance markets. The scarcity of doctors and hospitals makes it hard to build a network. Smaller populations mean there are fewer customers for insurers to sell to than they might find in more urban places.

The whole theory of Obamacare relied on both healthy and sick people signing up for marketplace coverage. The healthy people are crucial to balance out the bills of the sicker enrollees.

The Tennessee marketplace ran into trouble because it gave healthy consumers lots of ways to avoid joining the marketplace — a perfect storm of state and federal policy decisions that undermined the business case for insurers to sell Obamacare policies in the region. . . . It’s a self-inflicted wound.”

Tennessee layered on other policies that made it easier for healthy people to opt out of Obamacare. It appears to be the only state in the country that still allows some insurers to reject or charger higher prices to sick customers. This practice, called underwriting, was generally banned by the Affordable Care Act. A loophole in Tennessee law allows membership-only Farm Bureau plans to continue offering these products.

Georgetown University’s Sabrina Corlette has researched the Farm Bureau plans and estimates about 55,000 Tennesseans are currently purchasing non-ACA-compliant plans through the insurer.

The Farm Bureau plans, the weak individual mandate, the “if you like your plan you can keep it” promise — none of these policies on their own could take down the Affordable Care Act marketplace. But taken together, over the course of three years, they made it significantly easier for healthy people to decide not to enroll in the marketplaces. More than anyone, that hurts sick people.

Congressional Republicans led by Sen. Marco Rubio (R-FL) dubbed it the “Obamacare slush fund,” and in 2014 they inserted a provision into the 2015 federal budget requiring this program to be revenue-neutral.

Because health insurers experienced significantly more losses than payments, the program was only able to pay out 12.6 percent of the bills it owed. Small insurers like Community Health Alliance, a nonprofit planned that launched with a loan from the federal government, couldn’t survive that hit.

“They sort of knocked the breath out of us by taking away the risk corridor,” says Jerry Burgess, who served as chief executive of that plan. Community Health Alliance quit the marketplaces and went out of business in 2015 after the federal government did not pay millions in risk corridor payments that the insurer had expected.

The future of Obamacare under the Trump administration is less certain. Some places, like Florida and California, will be fine. They have big populations and urban markets that are attractive to health insurers.

Other places like Tennessee, more rural and low-income, may struggle. President Trump has given little reassurance to health plans that might be on the fence about entering Tennessee or other markets. His administration has waffled on whether it will continue funding key Obamacare payments. He has said he expects the marketplaces to “explode” on their own.

 That's right.  Republicans have worked to sabotage the law and withheld needed funding only to then claim the program is failing.  For rural hospitals, large numbers of uninsured individuals is financially catastrophic.  Required to stabilize people, they must treat them without payment.  In turn, they charge more for those who do have coverage and drive costs up further and make insurers more likely to want to leave the local market.  The death spiral only accelerates until hospitals go bankrupt and close, taking with them some of the best jobs in the area and depriving residents of ready access to hospital facilities.  It's as if rural areas have opted for a slow form of suicide.