At times, the debate over Trumpcare’s deregulatory aspects has looked like a distraction. Of course, the idea of people being priced out of the insurance market because of their preexisting conditions is morally odious. As is the prospect that families could once again be bankrupted by severely ill children reaching their “lifetime limits,” — or that opioid addicts may no longer be able to secure affordable coverage for addiction treatment on the individual market.
And yet, far fewer people would be hurt by these changes than the draconian Medicaid cuts that Paul Ryan passed. According to the Kaiser Family Foundation, less than 10 percent of Americans get their health insurance from the individual market. And, in all probability, only a small fraction of that group lives in a state that would take advantage of Trumpcare’s waivers for rolling back Essential Health Benefits and protections for those with preexisting conditions.
By contrast, 20 percent of Americans are covered by Medicaid. And the House GOP’s bill slashes funding for the program by $834 billion, so as to finance a large capital-gains tax cut for the rich. The human cost of that maneuver comes out to 14.4 million more Americans with no access to affordable health care.
This is the heart of Trumpcare.
By shifting public attention toward the bill’s regulatory changes, congressional Republicans have been able to perform gestures of moderation — without threatening their scheme to kick millions of poor people off their insurance for the sake of increasing income inequality. So, Fred Upton secures a few billion dollars for high-risk pools, the Senate GOP removes the waivers that let insurers discriminate against those with preexisting conditions, and Republican “moderates” can declare victory.
But now, it appears that the bill’s deregulatory provisions may be more consequential — and politically toxic — than Trumpcare’s critics and authors initially realized.
The Senate health-care bill will reportedly retain the House’s language allowing states to opt out of Obamacare’s essential-benefits requirements. This would free insurers to, among other things, sell plans that impose annual and/or lifetime limits on coverage benefits in some red states.
But it would also free America’s large employers to impose such limits on all of their workers, no matter what state they reside in. This is because, under existing regulations, employers that have operations in multiple states can chose to apply any one of those state’s insurance standards to all their businesses. In other words, if Utah allows insurers to cap lifetime benefits at $1 million — and a company has branches in Utah and California — then that company can ignore California’s ban on such limits and impose them on all their Golden State employees.
Right now, of course, Utah makes no such allowance, because Obamacare doesn’t let it. But Trumpcare would.
Before the Affordable Care Act was enacted, roughly 60 percent of workers were enrolled in an employer plan with a lifetime limit. When these workers or their family members contracted cancer — or other diseases that require expensive treatment — such limits often forced them into bankruptcy.
You might think that the desire to attract talent would prevent employers from reintroducing such limits. But a recent survey of large employers by Willis Towers Watson suggests that you would be wrong: Twenty percent of companies told the firm that they would impose annual limits, while 15 percent said they would impose lifetime limits, if Obamacare’s protections were repealed.
Using those findings and census data, the Center for American Progress projects that 27 million Americans with employer-based coverage would face annual limits if the Senate bill passes, while 20 would face lifetime caps.
That is a lot of people. And not just any people, but employed, middle-class ones, who tend to vote at higher rates than does the Medicaid population.
Trumpcare will still deliver the lion’s share of its blows to the latter group. Even if CAP’s estimates prove correct, only a fraction of that 27 million will hit their annual limit. The dark heart of the law remains upward redistribution.
But now, it looks like Republicans’ malevolent plans for the poor may prove less politically noxious than the deregulatory measures they slapped onto their bill to win over recalcitrant conservatives.