Tuesday, November 24, 2020

What Does Kelly Loeffler's Health Plan Do to Coverage for Preexisting Conditions?

I've been doing health policy for thirty years. I arguably know something about health insurance.

For the life of me, I can't figure out what Kelly Loeffler is proposing under her health plan––particularly when it comes to current protections for preexisting conditions.   

In 2017, Republicans proposed a plan that would have arguably given states the ability to reverse Obamacare's protections for preexisting conditions. Something I highly doubt states would have done if the Republican Obamacare repeal plan had passed. But states could have done it and that was enough for Democrats to jump on the possibility and make it a major issue in the 2018 elections––an election where Democrats made big gains.

The lesson Republicans should have learned from that episode is that it is foolish to tinker with preexisting conditions protections.

Now, this Georgia Senator is in a tight race to keep her Senate seat in a state Joe Biden just won.

Under these circumstances I would not be screwing around with the preexisting conditions issue.

You can access her four page plan summary here.

In the section titled, "Expand Affordable Health Insurance Options," she lists a number of steps she would take. While she condemns what Obamacare has done to the individual market in Georgia, she never says what she would do to the existing health care law aside from a few unconnected bullet point proposals.

Among her seven bullet points in this section, she says she would, "Establish guaranteed coverage plans to help patients with preexisting conditions." Why would she have to do this when current law now requires mainstream health insurance plans to cover preexisting conditions?

Is she proposing to repeal these current preexisting condition protections and replace them with separate high risk pool insurance policies just for people with preexisting conditions? 

We had high risk pools in some states prior to the 2014 preexisting condition reforms that occurred under the Affordable Care Act/Obamacare. These pools often covered less and cost more. 

It looks to me like Senator Loeffler is creating a huge opening for her Democratic opponent big enough to drive a big truck through.

Just like Republicans did in 2018 and paid a big election-year price for doing it.

Tuesday, November 10, 2020

The Supreme Court Will Not Wreck Obamacare Because the "Plane Has Not Crashed"

After hearing the Supreme Court's oral arguments this morning over the constitutionality of the Affordable Care Act (Obamacare), I can double down on my prediction the Court will not wreck Obamacare. 

If the conservative justices don't buy the plaintiff arguments, their attempts to destroy Obamacare will fail. Just two of the conservatives siding with the three remaining liberals would be enough to protect the health care law.

Listening to the arguments, at least three of the conservatives (Roberts, Kavanaugh, and Alito) were clear that whatever the Court does with what remains of the individual mandate the rest of the law should stand. 

The best comment came from one of the most conservative justices, Samuel Alito, over the question of whether or not the mandate can be severed and the rest of the law could continue to stand:

“In the first case [NFIB vs Sebelius, 2012], there was a strong reason to believe the individual mandate was … essential to keep the plane flying. Now the part has been taken out and the plane has not crashed,” Alito said. “How would we explain why the individual mandate in its present form is essential to the operation of the act?” 

Game, set, match. The Supreme Court will not wreck Obamacare!

Maybe the Court will strike down the hollow remains of the individual mandate. Aside from that, the only question left in my mind is whether or not the Court will be unanimous in upholding the rest of the health care law. 

Monday, November 9, 2020

The Supreme Court Will Not Wreck Obamacare

This is an update of an article originally posted in September.

With the Supreme Court due to hear arguments this week on a case brought by a number of Republican state attorneys general that could throw out the entire health care law, and with conservatives now having a 6-3 majority on the Supreme Court, there is great concern among ACA/Obamacare supporters that this could well mean the end of the health care law.

The Obamacare case currently before the court deals with the 2017 repeal of the law's tax penalty enforcing the individual mandate for people to buy health insurance coverage. In 2012, Chief Justice John Roberts cast the deciding vote in the 5-4 decision upholding Obamacare generally, and the individual mandate specifically, as valid under the Congress' taxing power. After the mandate's tax penalty was repealed in 2017, a number of Republican state attorneys general sued, arguing that since the mandate was no longer tied to a specific tax penalty, it had lost its legal underpinning. They also argued that because the individual mandate was key to a number of the law's provisions that made it a workable system of insurance, the entire law should fall, including preexisting conditions protections.  

Saturday, November 7, 2020

What a Biden Win Means to Health Care

Biden has won. 

Presuming the North Carolina and Alaska Senate seats remain in Republican hands,  the Senate will come out no better for Democrats than a 50-50 tie with Vice President-elect Harris being the tiebreaker. And, if Republicans win at least one of the two Georgia run-off Senate races, the Republicans will maintain control and the Democrats will not have the votes to move any partisan health care legislation.

But the Democrats will control the Department of Health and Human Services and the federal government's health care regulatory apparatus.

I will suggest that the health care plan Biden campaigned on can be summarized into three primary parts:

  • Fixing the Obamacare/Affordable Care Act (ACA) individual health insurance subsidies for the middle class. 
  • Giving Medicare the power to negotiate prescription drug prices.
  • Creating a government-run individual health insurance plan option called the Public Option.

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