The Affordable Care Act is a notoriously complicated and controversial piece of legislation, but one of the things almost everybody says they like about it is that it stopped insurance companies from denying coverage to individuals or charging extra because of pre-existing conditions. In other words, Barack Obama's signature law prevented sick people from being locked out of the US healthcare system solely because they are or have been sick. Both on the campaign trail and during last year's repeal debate, Donald Trump promised to uphold this principle. Other Republican leaders made similar vows, even as the actual legislation they proposed effectively weakened pre-existing condition protections in the name of driving down the cost of insurance plans. Though the repeal effort flamed out in the Senate, the Trump administration has continued to weaken the ACA in various ways.
And as the future of the ACA continues to be major issue in heated campaigns far away from the screaming drama of DC, Republicans have continued to lie about healthcare.
The small, but obvious, lie is what the president said at a Las Vegas rally last week: "Donald Trump and Republicans will protect patients with pre-existing conditions.” In fact, the administration is arguing in an ongoing court case that the ACA's pre-existing condition protections should be wiped out. This argument goes back to last year's tax cut bill, which among other things reduced the penalty people without insurance had to pay to $0, thus basically ending what was called the "individual mandate." The administration is now asserting that if there's no the mandate but insurers have to sell plans to everyone, people will simply avoid buying insurance until they get sick; therefore the pre-existing condition protections should be wiped out as well.
(This basically echoes the arguments ACA advocates made for the mandate in the first place: It was necessary to make the whole marketplace system work and keep plans affordable. The Republicans surely knew that the stripping away of the mandate would help them rip up pre-existing condition protections, of course. It's as if they smashed down a wall, then said, "Oh shoot, that was a load-bearing wall. Looks like we'll have to tear down the house.")
It's not just the Trump administration attacking this part of the law. That court case arose because 20 Republican state attorneys general sued to end the ACA earlier this year. Incredibly, one of those attorneys general is Josh Hawley, who is running for Senate and recently released an ad claiming, "I support forcing insurance companies to cover all pre-existing conditions."
Hawley might get points for pure chutzpah, but he's just one of many Republicans who are spending this election year crowing about how much they love pre-existing condition protections but hate the ACA. One recent installment in this routine duplicity is a Senate bill that would technically bar insurers from denying coverage based on pre-existing conditions but contains huge loopholes. As HuffPost reported last month:
Sure, premiums wouldn’t be allowed to vary based on health status or pre-existing conditions. But prices could dramatically vary based on age, gender, occupation and other factors, including hobbies, in ways that are functionally the same as basing them on medical histories. Insurance companies have a lot of experience figuring out that stuff.
This pre-existing condition rhetoric is the small lie. The larger lie is the notion that Republicans have any kind of healthcare plan at all.
Trump has made all kinds of extravagant promises about how "everybody’s going to be taken care of much better than they’re taken care of now.” But it turned out healthcare was complicated, and the legislative process during the ACA repeal effort was a mess that culminated in failure. As much as the right hated Obamacare, it turned out that there was no replacement plan that the GOP could unite around—possibly because the ACA, far from being a socialist plot, amounted to a fairly centrist scheme containing elements from a 90s Republican bill and the system created during Mitt Romney's tenure as governor of Massachusetts.
So instead of enacting reforms, Republicans have taken to using what tools they have to hack away mindlessly at the ACA: gutting the individual mandate, then saying that without an individual mandate pre-existing protections have to be torn up, all while simultaneously reassuring voters that actually they care a lot about pre-existing protections. They used to be able to talk vaguely about how bad Obamacare was, but after failing to replace it, Republicans can't even do that anymore.
Though it doesn't get as much attention from the national media as Brett Kavanaugh's Supreme Court nomination fight, healthcare is a hugely important issue to voters and Democrats have unleashed a wave of ads on the subject emphasizing the GOP effort to take away voters' health insurance.
That underscores that all the energy when it comes to healthcare is on the left. Democrats have proposed a variety of proposals to expand and strengthen coverage, whether that's Bernie Sanders's Medicare for all or more modest plans. Polls have uncovered broad support for these ideas—one survey from last month found that a slim majority of Republicans backed socialized medicine. Trump himself even (maybe accidentally) endorsed something that sounded like Medicare for all back in 2015.
It seems clear that Americans by and large want the government to help them get healthcare when they need it—whether that means the ACA's regulations on insurers or a more direct system where the feds or the states cover everyone. Republicans know this, which is why they are lying about wanting to defend pre-existing condition protections. More fundamentally, Republicans have spent the last decade using every avenue available to them to block any effort to expand coverage. Earlier this year, a GOP official even filed suit to prevent voters in Nebraska from deciding whether the state should expand Medicaid (this suit was rejected by a judge last month).
Republicans do not care whether anyone has health insurance—which is to say they effectively do not care whether lower-income Americans die or fall into crippling debt. If they did, they would have used their time in power to move the country toward universal healthcare, not away from it. When they try to tell you they care about this stuff, they are lying, every time.
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