As I write this, there is a newly filed challenge in Texas, in federal district court, a challenge which is explicitly designed to declare unconstitutional parts of the Obamacare provisions which prohibit insurance companies from denying coverage for pre-existing conditions, especially affecting employer-provided plans, and relaxes limits on what companies can charge older people and women. Those insured through employment could risk coverage loss when changing jobs or employment contracts. It would also increase difficulty in buying insurance on Obamacare exchanges and for those individuals who buy on the open market.
This move, though very unpopular, is backed by Trump, the Department of Justice, and 19 or 20 red state attorneys general, probably as payback for campaign funding by Big Insurance. If you haven’t yet heard of this, it’s because the politicians prefer it that way. This court filing tends to be something Republicans don’t like talking about. When pushed on it, they try persuading us that while they do support the challenge, of course they have plans to come up with other ways to see no one will lose coverage. Yeah, OK. This is and should be political dynamite because of the people in vast numbers who have qualifying pre-existing conditions. We shouldn’t forget the Kingsport-Bristol area is said to have the highest percentage nation-wide.
There’s no daylight at all between most embedded and comfortable Republican politicians and the Big Insurance lobby in how they see the benefit of “free market” health insurance, along with a minimum of pesky rules and oversight. The insurance giants have been chaffing under prohibitions against segmenting the market, the picking and choosing of their clients according to expected risk to their bottom line. Nothing would so fully give them back their old and cherished gate-keeping role as the right to discriminate, leaving decent health coverage affordable only for some, and re-instituting their former power over employer-provided plans. Let’s not forget, nary a one Republican congressperson voted for the implementation of Obamacare, mostly preferring the status quo.
In case you’re one of those who ever put any stock in Donald Trump’s campaign promise of the “beautiful” and oh-so-affordable healthcare he could initiate (maybe Canada-style he said) and hoped he’d be our hero and defender, time to think again. He just published an op-ed in USA Today to do his best at refuting and down-playing the hope for any type of Medicare-for-All system. The ease and rapidity with which fact checkers were able to prove almost every sentence contained misleading statements or falsehood was impressive. This one is a perfect example: “As a candidate, I promised that we would protect coverage for patients with pre-existing conditions and create new health care insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.” He didn’t mention drastic changes in guaranteed access and coverage.
If anything he says can be called a promise, he did indeed say it. If a promise, he broke it within a short time. He lined up to support the Republicans in their obsessive, ideological and politically jealous efforts to repeal Obamacare. (They, and he, called it “repeal and replace”, but no plan to replace was ever designed, much less presented.) Trump has supported every Republican plan that would have weakened protections for pre-existing conditions. If it were his intent to keep his campaign promise, he would not have added his support to the red-state attorneys general challenge now coming up in federal district court. Attorney General Jeff Sessions has put the weight of the Justice Department behind it, but Jeff Sessions has always been pro Big Insurance and therefore against Obamacare. He’s performing as expected, unlike Trump who’s about as distracting and entertainingly fickle as a two-year old.
As for his claim that we are now seeing premiums coming down, that’s patently false. They’ve continued to increase on average, although at a lower rate than in the past, which was the projection with Obamacare. Experts say that without Trump’s efforts to weaken Obamacare, with resulting market uncertainty, premiums would now be lower in many states.
I’ll have to save some 10 more false claims about Medicare-for-All systems in Trump’s op-ed for another time. But the take-away from his ramblings is Republicans have no intention of simplifying the hodgepodge of overlapping health insurance systems, probably because their Big Insurance donors derive power from the tangled complexity they themselves have created.
Most Democrats believe that single-payer health insurance could leave private initiative, innovation, and market forces strongly influencing provision of healthcare, and that Medicare-for-All should be welcomed as a stable and clear enough template to be rationally improved over time.
Judy Garland of Johnson City is a community health care activist.