Coming for Your Coverage, Trump’s Plot Against Health Care Continues

Adapted from; “Trump’s Plot Against Health Care Continues, He is still coming for your coverage and lying about it., NYT Opinion, Paul Krugman, January 13, 2019.

Trump in a tweet: “Mini Mike Bloomberg is spending a lot of money on False Advertising. I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate…..”

As one reporter noted, President Trump was not in office when the PPACA established a unpenalized right to healthcare even if you had pre-existing conditions. Much of Trump’s efforts since taking office has been to wipe away President Barack Obama’s legacy of which the PPACA was a major accomplishment in spite of the well known resistance to his even being in office coming from Republicans “even” before he took office. Due to President Trump’s efforts, key parts of the PPACA have been removed and legislation pushed through a majority Republican Congress attempting to repeal the PPACA. The DOJ is now attempting to have the PPACA repealed before . . . nope, now after the election so the blame can not impact it.

Prior to this latest lie by Trump, an earlier lie in 2019 had the Administration work through the CMS to take action against protections for people with pre-existing conditions by allowing states to let individual market insurers vary premiums and cost sharing based on “health outcomes.” A new CMS project allowed up to ten states to apply and then establish “health-continent wellness programs.” The state programs would let insurers vary premiums and cost sharing by as much as 30 percent based on upon an enrollee’s meeting designated health outcomes, a return to charging sick people more than healthy people.

So there has been an unending stream of efforts to repeal or stymie. (More Krugman after the leap)

A day ago Paul Krugman noted; “Health care will be on the ballot this November, but not in the way ardent progressives imagine.”

“Democrats running for president have spent a lot of time debating so-called Medicare for all, with some supporters of Bernie Sanders claiming that any politician who doesn’t demand immediate implementation of single-payer health care is a corporate tool, or something. But the reality is that whatever its merits, universal, government-provided health insurance isn’t going to happen anytime soon.

I say this because  .  .  .  even if Democrats take the Senate in addition to the White House, the votes for eliminating private health insurance won’t be there; nor will the kind of overwhelming public support that might change that calculus. In practice, any of the Democratic candidates — even Sanders — will, if victorious, end up building on and improving Obamacare.”

(note to readers: There is a way to get free limited access to the NYT and Paul Krugman if you sign up for it)

And if Trump takes the presidency, you can be assured he will keep looking for a way to repeal the PPACA and disenfranchise tens of million more, well beyond what is occurring in states today which did not expand Medicaid, beyond the rising healthcare insurance premiums, deductibles, and copays, and those increases due to the healthcare industry’s continued upward pricing adjustments. And neither is there any assurance after an end to the PPACA, there would be a move immediately to Single Payor.

To get to the Golden Fleece of healthcare called Single Payor where a government entity sets budgets for and pays hospitals, sets fees for doctors, and controls pharma prices; half of America still needs to be convinced Single Payor is a better way to get healthcare than through commercial healthcare insurance which passes along the costs of the healthcare industry plus a 15 -20% adder on top of those costs in the form of premiums, deductibles, copays, and disapproved billings or surprise bills. Politicians beholden to the healthcare insurance and healthcare industries have done an excellent job of convincing people it will not work even though it does work in other countries separately or in conjunction with commercial healthcare insurance.

Krugman: There’s a sort of perverse alliance between Republicans and some progressives, both of whom are determined, albeit for different reasons, to see the Affordable Care Act as a failure.

Much of the PPACA implementation was left up to the states, and “that national performance has been held down by many states that have done their best to sabotage health reform.” However in 2010 California, before the A.C.A. went into effect, had 21 percent of its nonelderly Californians uninsured and above the national average. By 2016 the uninsured rate had dropped to 8 percent. Californians with pre-existing medical conditions saw an enormous improvement in their health and financial security.

While 8% is still too high, with improvements to subsidies and an improved sliding scale of application of subsidies coupled to cost controls or negotiation of pricing of the industry, improvements in coverage could be achieved. As Krugman points out “does pointing out the possibility of incremental progress mean giving up on a truly universal system?” No, and Kocher and Berwick’s “While Considering Medicare For All: Policies For Making Health Care In The United States Better” sets a path on how it could be done.

Back to Krugman: “The repeated attempts to kill the PPACA have failed in both the courts and legislature and the efforts to undermine health reform and send insurance markets into a ‘death spiral’ have fallen short. The latest attempt being the lawsuit the DOJ is now attempting is to delay till after the election. In it, the DOJ claims the 2017 tax cut, which reduced the penalty for not having insurance to $0 somehow made the entire Affordable Care Act unconstitutional. It’s a ludicrous claim, both in terms of substance — would the law suddenly become constitutional if the penalty were a penny? — and because it’s clear that this was not the legislators’ intention.”

While the Trump administration had joined the suit, a partisan Republican judge ruled the A.C.A. as a whole should be struck down. The case is heading to the Supreme Court and Trump doesn’t want it heard until after the election. Even with the partisan slant of SCOTUS as Krugman identified, they could decide the lower court ruling and the lawsuit as being ludicrous. Trump’s political strategy for healthcare is to out right lie about what he has done since taking office and what he is going to do. In the end, this one particular lie will touch the lives of millions of voters for whom he wants to take away healthcare; however, he doesn’t want them to see him doing it and will wait to do it after the election is behind him.

“And the question about election year healthcare, will it be expanded coverage under a Democrat or will there be tens of millions of newly uninsured Americans under Trump?”