RED ALERT: Zombie Trumpcare is back on again, this time with MOAR AWFULNESS!


(sigh) Yes, this is the third time I've used the exact same clip from "Dead Again". That's no coincidence; Zombie Trumpcare keeps shuffling back every few weeks, but this time they appear to actually be serious about it (again).

Others have already written up more detailed explainers on the latest changes, so I'm not gonna go into too much detail, but Sarah Kliff of Vox wraps it up nicely:

Republicans’ new health amendment lets insurers charge sick people more, cover less

Here's the basics: In addition to (or in revised versions of) everything awful about the AHCA ("American Health Care Bill") which gave it a mere 17% approval and led to it being yanked off the House floor mere moments before it was scheduled to be voted on, the new version also includes the following:

  • Individual states would be allowed to charge more for pre-existing condition coverage
  • Individual states would be allowed to opt out of covering essential health benefits
  • Individual states would be allowed to charge older people up to 5 times as much as younger enrollees.

Basically, it's the same thing the hardliners in the House Freedom Caucus wanted before, except that they would get to pass the blame over to the states instead of Congress itself.

The only bones thrown to the so-called "moderate" wing of the party (hah!) is that:

  • The massive rate hikes for those with pre-existing conditions could only be charged to those with a break in their coverage, and
  • It would only be allowed if the state participates in the "Patient & State Stability Fund" established by the main part of the law.

However, as Kliff notes:

Republicans’ operating theory here is that it’s okay for states to charge sick people higher premiums so long as they have some kind of fallback option for coverage, like a high-risk pool. But health law expert Tim Jost points out that states don’t have to use their stability funds to create high-risk pools, which means these people could find themselves out of luck.

“The idea was people who fall through the cracks would have a high-risk pool,” he says. “What happens though if a state uses their money for reinsurance instead?”

Of course, even if they do create High Risk Pools, those have a terrible record of being massively underfunded, so that'd still be pretty small comfort.

The GOP amendment would allow states to opt out of these provisions if they show that the change would lead to “reducing average premiums for health insurance coverage in the State.” If the federal government took no action when these applications came in, the waivers would be automatically approved after 60 days.

Yes, that's right: All it takes for a state to kill off requiring health insurance policies to actually cover, you know, healthcare treatment is to "prove" that doing so "would reduce premiums", which of course it would, for the same reason that removing the tires, steering wheel and engine from a car would reduce the price it sells for...not that it matters, since apparently HHS Secretary Tom Price wouldn't even have to check and see whether the waiver request even did "reduce premiums", since the application would be automatically approved by default unless he actively gave it a thumbs down.

This does not set an especially high bar for this waiver option. It means that states could, for example, end the essential health benefits requirement because they believe it will lower premium costs. And of course it would! Tell insurers they no longer have to cover expensive mental health services or maternity care, and average prices would almost certainly drop. The same would happen if insurers had the option to charge sick patients prices they couldn’t afford. Those people would drop out of the market, and premiums would decline.


In another nice catch by Kliff (actually, by Timothy Jost who gave her the heads up), it appears that the GOP made sure that THEY continue to receive full coverage of pre-existing conditions and all 10 of the ACA's Essential Health Benefits (EHBs) no matter what happens to anyone else:

If Congressional aides lived in a state that decided to waive these protections, the aides who were sick could be vulnerable to higher premiums than the aides that are healthy. Their benefits package could get skimpier as Obamacare’s essential health benefits requirement may no longer apply either.

This apparently does not sound appealing because the Republican amendment includes the members of Congress and their staff as a protected group who cannot be affected by this amendment.

You can see it on the sixth page of the amendment, although it is admittedly hard to spot. The Obamacare section that requires legislators to buy on the individual market is section 1312(d)(3)(D). And if you look at the Republican amendment, and the list of who cannot be included in this waiver? It includes Section 1312(d)(3)(D).

Yup. As Adrianna McIntyre put it:

Comprehensive health insurance for me but not for thee

— Adrianna McIntyre (@onceuponA) April 26, 2017


On top of everything else comes this out-of-left-field bombshell from Dana Milbank in the Washington Post:

Apparently repealing Obamacare could violate international law

...The United Nations has contacted the Trump administration as part of an investigation into whether repealing the Affordable Care Act without an adequate substitute for the millions who would lose health coverage would be a violation of several international conventions that bind the United States. It turns out that the notion that “health care is a right” is more than just a Democratic talking point.

A confidential, five-page “urgent appeal” from the Office of the U.N. High Commissioner on Human Rights in Geneva, sent to the Trump administration, cautions that the repeal of the Affordable Care Act could put the United States at odds with its international obligations. The Feb. 2 memo, which I obtained Tuesday, was sent to the State Department and expresses “serious concern” about the prospective loss of health coverage for almost 30 million people, which could violate “the right to social security of the people in the United States.”

You'll note that I'm sort of throwing this last point in as a minor add-on to this entry, mainly because given all of his other crimes and norm violations, I'm pretty sure that "not complying with UN conventions regarding healthcare policy" is pretty low on the Trump Administration's radar, and I'm not sure there's much the UN could do about it anyway. It's more of a narrative-building item than anything. As Milbank notes:

Though of questionable legal value, the U.N. letter is at least a bit of moral support for those defending Obamacare. Those attempting to deny health care to tens of millions of Americans would hurt their own constituents in a way that falls short of the standards we hold for ourselves and other countries.

....The Trump administration has shown its contempt for such considerations by failing to pass along the U.N. letter to congressional leaders. But you don’t have to care about international law to know that the essence of the OHCHR criticism is true: Taking away health coverage from millions without an adequate replacement is abject cruelty.

In any event, Paul Ryan & Co. want those tax cuts for the super-rich, dammit so apparently they're gonna try dipping into this well one more time no matter what...

Anyway, it's time to call your member of Congress again. Here's three key links folks should refer to when doing so: