Trumpcare Is Medical Apartheid

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

Source: Trumpcare Is Medical Apartheid

Jonathan Alter 05.02.17 10:00 PM ET

Jimmy 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.

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