Trumpcare Is Medical Apartheid

By Jonathan Alter, The Daily Beast

03 May 17

Before Obamacare, if you were denied coverage and then got sick, you were thrown to the wolves.

immy Kimmel was weeping on his show this week. After describing the heroic efforts of doctors to fix the heart defect of his newborn son, Billy, he said that baby Billy would be dealing with this congenital condition when he was a teenager and beyond. Then his thoughts turned to people who are not the children of late-night talk-show hosts. He told the audience that important meetings are underway in Washington right now. “No parent should have to decide if they can afford to save their child’s life,” he said to thunderous applause.

Before 2010, millions of parents were faced with just that decision. As we wait to see if Republicans can ram through their new version of the health care bill—and I give them decent odds in the House—please join me on a quick trip back in time on this most wrenching of issues. It’ll help clarify the breathtaking cynicism of the GOP.

I’m talking here less about President Donald Trump, who wouldn’t know a community rating from a Nielsen rating if his life depended on it, than about other dishonest “public servants” who should know better, like House Speaker Paul Ryan, HHS Secretary Tom Price and Rep. Tom MacArthur, the New Jersey conservative who fashioned the latest compromise with the far-right Freedom Caucus.

Democrats are hardly covering themselves with glory on this one, either. Their efforts to defend Obamacare are often arid, abstract and disconnected from the powerful moral imperative at the heart of this issue.

First, the context. Let’s return for a moment to the Great American Double-Whammy—the way millions of Americans lost their health and their savings at the same time. Before Obamacare, more than half of all personal bankruptcies were caused by onerous health-care costs. Those who didn’t go bankrupt often sold their homes or spent much of their net worth to pay for their care or that of an ailing loved one. It wasn’t just cancer or heart disease that prevented people from getting insurance. High blood pressure, kidney stones, even allergies could be enough to deny you coverage. Then, if you got sick, you were thrown to the wolves. It’s hard to believe we lived so long in that shameful world.

While we did, Democrats advocated some kind of national health insurance—at least catastrophic coverage. Republicans mostly opposed it, but they had to figure out some way to deal with the middle-class Billy Kimmels of the world.

So state policy-makers came up with something called “high-risk pools,” where insurers would all contribute to help cover their outcasts, the ones they didn’t want wrecking their profits because of preexisting conditions. This sounded like a decent stop-gap idea and in the 1990s and 2000s it spread to 35 states.

Sadly, high-risk pools were a colossal flop. In 20 states, legislators provided no money to help with premiums for those in the pools. That meant few could afford the coverage. Only 226,000 out of 40 million uninsured—less than one percent—took part. In California, for instance, fewer than 1,000 people in the entire state were in the high-risk pools.

Now Trump, Ryan and company are pretending that these proven failures—state-run high-risk pools—are the way to keep their promises to anyone who has ever had a chronic or serious health problem. The president says with a straight face that those with preexisting conditions—one quarter of all middle-age and older Americans—will be “taken care of.” The speaker put out a press release Tuesday saying it was a “verified” fact that the new compromise bill would cover them. His proof is the high-risk pool—the Health Insurance Risk Sharing Plan (HIRSP)—in his home state of Wisconsin.

As Ryan brags, Wisconsinites enrolled in the high-risk pool were generally glad that they finally got covered after years of being stiffed for preexisting conditions. Problem solved! Thanks, Paul!

But it turns out that HIRSP coverage was inferior and more expensive than what these folks later obtained under Obamacare. Most important, the Wisconsin high-risk pool—one of the best in the country and now the GOP’s model for the nation—insured only 22,000 out of roughly 500,000 uninsured people in the Badger State.

In the face of this large and inconvenient fact, Ryan was shameless enough to get his picture taken on the Speaker’s Balcony with young women survivors of childhood cancer, implying that they wouldn’t have anything to worry about under the new plan unveiled last week. In truth, should Ryan gets his way, these women are likely to be priced out of coverage for the rest of their lives if they happen to live in one of 20 or so states that would likely be granted waivers to let insurers avoid the community ratings that require them to treat all customers equally. That’s policy-speak for letting states and insurers kick these cancer survivors to the curb.

The speaker knows all this, which means that his intellectual dishonesty knows no depths. Any pundit who ever falls again for Ryan’s faux policy-wonk act should find another line of work.

And any Democrat who neglects the moral and ethical dimension of this issue should not seek reelection.

For years, Democrats have claimed that healthcare is a “right,” a notion I have generally embraced. But it’s a political right in a society that can afford it, not a moral right. There is no inalienable right to dental coverage.

The movement for ever-expanding rights is increasingly unpersuasive to many Americans when it is disconnected from wrongs—from tangible signs of abuse and discrimination.

Pricing sick people out of insurance coverage is abuse. It will make them go to the doctor less often, meaning less early detection and more early death.

And discrimination against sick people is as morally wrong as discrimination against people because of the color of their skin. High-risk pools are American Sowetos in a system of medical apartheid.

If Democrats can make this about discrimination against millions of Americans, they will crystallize the issue and re-take the Congress in 2018.

The latest betting is that the new version of Trumpcare—which would, like the old bill, throw 24 million Americans off health insurance— will fall short. The old plan was supported by a paltry 17 percent of the public before it was withdrawn in March and this one is harsher and more hypocritical. It’s especially hard on those age 40 to 65—many of them Trump voters—who can now be charged premiums five times as high as those of younger people, instead of the three-to-one ratio in the earlier GOP bill. We’re told none of this augers well for passage.

I’m not so sure. The White House and GOP-controlled Congress desperately need a win to show the conservative base they can deliver. They also need the money saved from throwing millions off of coverage to help fund their tax cuts for the wealthy.

Few have noticed that the fate of tax reform—the only thing that unites the whole GOP— is tied up with that of Trumpcare.

In the House, where the deal with the Freedom Caucus has given the bill new life, some moderates may now defect. But others—like Rep. Rodney Frelinghuysen, chairman of the House Appropriations Committee and thus influential with colleagues—have moved from opposition back toward support.

It’s widely assumed that the Senate wouldn’t back the House version. But that hardly kills the bill. The momentum created by House passage might well force the Republican-controlled Senate to produce some kind of legislation. A handpicked House-Senate conference committee would then likely compromise on a final version that would, without question, be worse for those with preexisting conditions than the status quo.

According to his father, little Billy Kimmel looks like he’s going to be OK. But the future of his health insurance is in doubt. The same goes for the rest of us who have faced health challenges at some point in our lives.