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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

GOP Sabotage of Preexisting Conditions Coverage a Big Gift to Dems

The Republican Party has become so extreme that Democrats can win midterm support from voters as a result of GOP positions on any of a long list of issues. But if Democrats had to pick one issue to focus on, in most cases it would be health care in general, and the Republicans gutting coverage for pre-existing conditions in particular.

As Robert Pear explains at The New York Times:

The Trump administration issued a final rule on Wednesday that clears the way for the sale of many more health insurance policies that do not comply with the Affordable Care Act and do not have to cover prescription drugs, maternity care or people with pre-existing medical conditions…Democrats derided the new policies as “junk insurance” that will lure healthy people away from the broader insurance market, raising premiums for sicker people and putting purchasers at risk.

…People who buy the new policies and develop cancer could “face astronomical costs” and “may be forced to forgo treatment entirely because of costs,” said Chris Hansen, the president of the American Cancer Society Cancer Action Network.
…In the past year, the Trump administration has also cut funds for groups that help people sign up for coverage; ended cost-sharing subsidies paid to insurers on behalf of low-income people; and asked a federal court to throw out parts of the Affordable Care Act, including the popular protections for people with pre-existing conditions.
We are not talking about a small number of people who are affected by the GOP’s assault on coverage of pre-existing conditions. As Margaret Sanger Katz notes at The Upshot:
More than a quarter of working-age adults have a pre-existing health condition, like asthma, diabetes or cancer, that might have locked them out of the insurance market in the years before Obamacare, according to research from the Kaiser Family Foundation. Surveys show that far more have a friend or family member with a serious medical problem. Because health problems tend to pile up as people age, the older voters who tend to turn out most reliably in midterm elections experience such worry disproportionately.
Amy Goldstein elaborates at The Washington Post, “In the months since the idea surfaced, it has elicited a wall of opposition from the health insurance industry, hospitals, doctors and patient advocacy groups. All have warned that consumers with bare-bones plans would be stranded when they need care — and that the defection of healthy customers from ACA market­places would drive up prices for those who remain…Topher Spiro, vice president for health policy at the liberal Center for American Progress, derided the health plans as “junk insurance” and “the Trump University equivalent of health insurance.” Further,
Both types of insurance can sidestep the ACA’s requirement that health plans sold to individuals and small businesses must include 10 categories of benefits, including maternity care and mental-health services. Both can have bigger price differences between older customers and younger ones. But only the short-term plans also can charge higher prices to customers with medical conditions that require care, refuse to sell them a policy, or exclude coverage of health problems that a customer had before buying the insurance. The ACA bans such practices.
Democratic candidates are doing their best to hold the Republicans accountable in the midterm elections. Sanger-Katz writes that,
After nearly a decade of playing defense on the issue, Democratic congressional candidates around the country are putting a health care message at the center of their campaigns. After the Republicans’ failed effort to repeal the Affordable Care Act, Democrats have detected a newfound concern that the consumer protections established under the law might go away. And that fear has turned into a potent campaign theme.

…“I completely can see why they’re excited to be able to talk about this issue again,” said Mollyann Brodie, a senior vice president at Kaiser, who runs the group’s public opinion polling. The foundation’s most recent survey, released last week, found that pre-existing conditions had become the most important health care concern among voters, ranked the most important campaign issue for many of them over all. “I agree with the strategy, based on our polling and everyone else’s polling. It’s a time when it is going to work.”

It’s not just red-state Democratic senators who are focusing on pre-existing conditions. The issue is coming up in House races across the country. Tyler Law, a spokesman for the Democratic Congressional Campaign Committee, ticked off districts — in Arkansas, Washington, New Jersey — where it’s a major campaign theme. In markets with close races, the committee is running its own advertisements on health care…“We’re seeing candidates in every single district talking about health care,” he said. “There is nowhere this does not play.”

Pre-existing condition protections have always been much more popular than the law over all…The Trump administration’s position is that most of the [ACA} law should remain on the books, but that its protections for people with pre-existing illnesses should be stripped away.

At New York Magazine, Jonathan Chait provides the most accurate description thus far of the Republican ‘alternative’ to Obamacare:

But whenever Democrats have attempted to expand access to health care, Republican leaders have generally declined to present themselves as principled opponents of universal health care. Instead, they have promised they could accomplish the same goal in a better, cheaper fashion, without any of the painful trade-offs in the existing Democratic-authored proposals. No such plan ever emerged, in part because Obamacare was the most market-friendly way to accomplish the bare minimum objectives of any humanitarian health-care reform. The only space to Obamacare’s right involved punishing the poor and sick with medical and financial deprivation.

…What is striking about the Trump-era Republican health agenda is the lack of policy ambition. Having spent years insisting they had an army of wonks who could design a better alternative to the Obamacare “train wreck,” the Republican plan of attack has dissolved into a rearguard sabotage campaign with no pretense of doing anything to help the poor and sick afford medical care. Health care remains a policy ground with which conservative-movement dogma cannot grapple.

The utter failure of Republicans to come up with a rudimentary alternative health care plan, even with the presidency and majorities of both houses of congress and the Supreme Court, is really quite pathetic. Chait’s description of their “plan” as “a rearguard sabotage campaign with no pretense of doing anything to help the poor and sick afford medical care” is exactly right. On November 6th, the bill comes due.

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