50 ways to kill your health care

Republicans are singing a new song since failing to repeal the Affordable Care Act in March. The flurry of verses includes ending basic benefits, charging sick people higher premiums, and destroying the current system through uncertainty. With apologies to Paul Simon, their song sounds something like this:

The problem is all inside your head, he said to me,
but there’s no coverage for your therapy.
The answer is easy if you post a GoFundMe,
There must be fifty ways to kill your health care.

Raise that deductible, Jill, and premiums, too, Lou,
No more Medicaid, babe, just listen to me.
So I repeat myself, at the risk of being cruel
There must be fifty ways to kill your healthcare.

Despite Republican predictions of disaster, Obamacare is stabilizing, not exploding. The problems come from uncertainty, as Trump administration waffling and misdirection leave insurance companies in the dark about what next year will bring. Vox reports:

“The White House’s decision to stay mum on certain health policy issues — particularly whether it will fund key Obamacare payments for low-income enrollees — has left insurers skittish about selling marketplace coverage in 2018.”

According to Pennsylvania insurance commissioner Teresa Miller:

“You had a couple of members of Congress talking about how they’ll wait for the marketplaces to collapse,” she says. “All of a sudden our insurers are like, “Oh, no. If you all want to make it fail, that can happen.”

One way to blow up the system, Vox explains:

“CSR. It stands for cost-sharing reductions, which the federal government pays to health insurers to lower cost sharing (things like deductibles and copays, for example) for the poorest Obamacare enrollees. Last year, the federal government paid out $7 billion through this program.

“The House filed a lawsuit in July 2014 arguing that Congress didn’t actually appropriate the money for those funds, and therefore the administration should not continue to make these payments. Nick Bagley wrote an excellent in-depth explainer on the lawsuit if you want to learn more.

“Long story short: The Trump administration has to decide whether it will continue to defend these CSRs — or if it will concede to the House’s case (that the administration doesn’t have authority to make these payments) and end a multibillion-dollar Obamacare funding source….

“Insurers are desperate to know what happens to these Obamacare payments. Before deciding to enter markets or what premiums to charge they want to know if this $7 billion fund will stick around.”

This analysis comes from Vox’s daily health care newsletter, written by the very savvy Sarah Kiff. It’s readable, smart, and cuts through a lot of the jargon and double talk around the health care/health insurance debates. (If you want to keep up on health policy, you can sign up here for the Vox newsletter.)

And that “death spiral” that Trump keeps talking about? Not happening. The Obamacare non-group market is actually getting profitable for insurance companies. A Standard & Poor’s report shows insurance companies in the individual market turning gross profits in 2016, after losses in 2014 and 2015.

But that only happens if the Obamacare/Affordable Care Act remains in place – not if Republicans blow it up.

One way to blow up the entire non-group market is to end the cost-sharing reductions, as discussed above.

Another way is to end community rating, thus allowing insurance companies to charge different premiums to people who are healthy and people who are sick. That would drive premiums up so far that sick people could no longer afford any insurance.

A third way is by removing the essential health benefits requirement – allowing insurance companies to exclude coverage for cancer or for addiction treatment or for mental illness or for delivery of babies.

Meanwhile, across the country, universal health care supporters are organizing. As unlikely as passage is in a Republican Congress, they continue to build support, looking to the future.

For more:

• This is how Obamacare might actually explode (Washington Post, 4/11/17)
• Universal healthcare supporters see their chance: ‘There’s never been more support’ (The Guardian, 4/11/17)
• How U.S. Health Care Became Big Business (NPR, 4/10/17)
• The GOP’s new Obamacare repeal push is in flux. Here’s what we know.(Vox, 4/4/17)
• Insurance regulators are panicked about Obamacare’s future (Vox, 4/10/17)
• The bizarre lawsuit that could still blow up the ACA insurance markets (Vox, 3/29/17)