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Does the health care bill the House passed maintain protection for people with pre-existing conditions, or not?

REUTERS/Carlos Barria
The House’s passage of the American Health Care Act has sparked a debate about whether the bill would protect people with pre-existing conditions from exorbitant premium hikes.

Barely an hour after the American Health Care Act passed narrowly out of the U.S. House of Representatives, the Democratic Congressional Campaign Committee — the Democratic Party arm tasked with taking back the House — started running digital ads slamming Republicans for their vote in favor of the GOP’s proposed replacement of the Affordable Care Act.

A key line of attack? That Republicans decided to destroy protections for people with pre-existing conditions — any kind of health condition that makes someone more expensive to insure as they seek coverage.

“The Republican health care bill: no more protections for people with pre-existing conditions,” the DCCC ad declared.

Minnesota’s three Republican representatives, all of whom voted in favor of the bill, painted a much different picture: they believe the bill will expand access to affordable health coverage, and have maintained that it won’t do anything to jeopardize the coverage of those with pre-existing conditions.

Third District Rep. Erik Paulsen, who was publicly undecided until just hours before the vote, appeared to make clear that pre-existing conditions protections were essential to his support of any bill. In an April 14 letter to constituents, he said that “Any reform efforts should maintain important provisions that expand access to health care. These include protecting patients with pre-existing conditions.”

In an op-ed in the Star Tribune this week, Paulsen said the AHCA is “aimed at addressing many of the shortcomings of the ACA by stabilizing insurance markets and beginning to bring down premiums… Nothing in this bill would allow an insurance company to deny someone coverage, including to those with a pre-existing condition.”

Second District Rep. Jason Lewis, in an interview with MinnPost, said he believes the AHCA will “be beneficial for everyone, especially the sicker folks and folks with pre-existing conditions. Otherwise I wouldn’t have voted for it.”

In a statement after the vote, 6th District Rep. Tom Emmer said the AHCA “protects Americans, ensuring they cannot be denied coverage based on their gender or whether or not they have a pre-existing condition.”

It’s not uncommon for political rhetoric from opposite sides to say apparently contradictory things, but who’s right in this case? Does the AHCA protect people with pre-existing conditions, or not? As with most things having to do with health care — and to the surprise of some — the answer is complicated.

Waiving goodbye to Obamacare

If the AHCA were to move forward and become law as it is written right now, states would have a lot of flexibility and a range of options to comply with the law. That flexibility, giving more power to the states, is a big selling point for Republicans on the new law, but the choices also come with major consequences for insurance access. (The U.S. Senate is poised to make major changes to the House bill, but let’s leave that alone for now.)

The AHCA leaves some aspects of Obamacare in place — such as the provision allowing those under age 26 to remain on their parents’ plans — and totally repeals others, like the requirement to hold health coverage or else face a tax penalty, which is known as the individual mandate.

States can’t change these things. But the AHCA, as passed by the House, does give them the option to seek an exemption from two key parts of Obamacare. States may submit waivers to Washington to get out of complying with two elements of Obamacare that are preserved in the letter of the AHCA: essential health benefits, and community rating.

The essential health benefits provision, under Obamacare, requires insurers to cover 10 benefits, from prescription drugs to prenatal care, in any health care plan they offer. Community rating is a provision that prohibits insurers from charging any person more based on their individual health status — important if you have a pre-existing condition.

Under the GOP’s proposal, Washington can only approve waivers from states if their proposals meet certain conditions, such as lowering premiums, stabilizing the market, stabilizing costs for those with pre-existing conditions, and/or expanding the choices available.

Proponents argue that the criteria for waivers is strict — states must ensure “no one is left out in the cold,” writes National Review’s Rich Lowry — while critics, like Washington and Lee University health care professor Tim Jost, counter that “essentially, any state that wanted a waiver would get one.”

Why would a state apply for a waiver? The AHCA reduces significantly federal subsidies for monthly premiums — and it’s unlikely states would be able to make up the difference. With no individual mandate for coverage, healthier people would likely withdraw from the market, leaving older and sicker people remaining in the pool.

As a result, insurers would likely flee those states, so state authorities would feel compelled to cut essential health benefits and community rating in an effort to keep insurers in the market.

That’s because those waivers would, experts say, allow insurers to charge some patients significantly more for health coverage, particularly those with pre-existing conditions.

Essential health benefits

How would that happen? Consider essential health benefits: with a waiver, a state could set its own definition of what insurers are required and not required to include in their health plans.

If an insurer is losing money in a state, it either needs to charge people more or limit the amount it pays out for health care. States could entice the insurers to stay in the market by giving them room to raise patients’ cost of coverage by excluding some current essential health benefits from insurance plans.

If a state no longer makes insurers provide basic coverage for prescription drugs for someone with a chronic condition like HIV/AIDS, for example, a patient’s out-of-pocket cost would substantially rise, and reduce the insurer’s risk.

That, critics say, effectively makes any condition requiring treatment with prescription drugs a pre-existing condition that could make the cost of obtaining insurance prohibitively high.

Community rating

But the provision of the AHCA waivers with potentially more far-reaching effects is the end of the community ratings provisions in Obamacare.

Matt Fiedler, a health policy expert at the Brookings Institute, explains that “under the ACA, what [community rating] means in practice is for a person of a given age and given location, everyone has to pay the same premium,” he said.

Community rating existed before the ACA, but it did not work well because there was no individual mandate for coverage. Getting healthy people to join insurance pools that didn’t charge more for costlier patients — thus raising the healthy people’s own premiums — was a tough proposition, states found. But with everyone required to have insurance or pay a penalty under Obamacare, the problem was somewhat mitigated.

The AHCA would get rid of the individual mandate, and it would also end a lot of federal subsidies to incentivize people to purchase care. Instead of a mandate, the AHCA proposes that insurers charge a patient 30 percent more in premium payments upon entering the health care market if that patient does not have “continuous coverage,” which is defined as a lapse in insurance coverage for more than 63 days in the last year.

But the premium hikes for people with pre-existing conditions could be much higher under the proposed law. That’s because, aside from the 30 percent penalty, people who had allowed their coverage to lapse might no longer be eligible for premiums based on community rating, but instead could be assessed premiums based on “health status” — meaning insurance companies could charge sick people much higher premiums than their healthy peers in the same age group.

The effect, Brookings’ Fiedler explains in a blog post, is that “health status would replace the 30 percent premium surcharge” for people without continuous coverage.

How costly could that hike be? Significant, explains Gary Claxton, a vice president at the health care policy nonprofit Kaiser Family Foundation, and a former Bill Clinton administration official at the Department of Health and Human Services.

If someone doesn’t demonstrate continuous coverage, Claxton says, “there’s no limit of what they can be surcharged. They can be charged as much as the insurer wanted.” That, he says, is effectively the same as being denied coverage outright.

Does that mean, though, that as long as you maintain continuous insurance coverage, you’d be protected from dramatic premium hikes? Not necessarily.

Brookings’ Fiedler explains that in a waiver state, insurers could set two different ways to charge people in the individual market: one that is technically community-rated, designed for people who have demonstrated continuous coverage.

But the problem comes from the fact that insurers would be free to set up a separate pool that uses health status, rather than community rating, to determine premiums for people who haven’t maintained continuous coverage. As explained above, that could result in prohibitively high premiums for people with pre-existing conditions. But it also allows insurance companies to offer health plans with extremely low premiums to healthy people, based on their overall good health status.

Healthy people could save hundreds or thousands of dollars by leaving the community-rated pool and paying premiums based on their health status. Consequently, the people left in the community-rated pool would be relatively sicker, which means insurance companies would need to raise premiums for that group.

Fiedler concludes that ultimately, “premiums in the community-rated pool would have to be set at a prohibitively high level, leaving people with serious illnesses with no affordable options, whether or not they had maintained continuous coverage. Many of these people would likely be driven from the individual market entirely.”

High-risky business

Republican backers of the bill say that their critics are blowing the pre-existing condition debate out of proportion. They are quick to offer what they see as important context as to how many Americans would actually be affected by changes to insurance rules.

“I would say, number one, that the whole pre-existing issue does not apply to 93 percent of Americans,” Paulsen says, since the AHCA’s language affects the Americans who obtain insurance through the individual market. Eight percent of Minnesotans have coverage in the “non-group,” or individual market — people who don’t get insurance through an employer or through Medicare or Medicaid.

Still, the AHCA’s supporters maintain they aren’t ignorant of those who could be affected by changes: they say they have set up safeguards to prevent a worst-case scenario for those with pre-existing conditions — the most important of which are high-risk pools.

High-risk pools are insurance pools for the sickest and costliest patients in the health care market, and they exist as a way for states to offer health coverage to people with pre-existing conditions who are considered uninsurable by insurance companies.

They were a feature of the health care landscape before Obamacare, and were funded in different ways by different states. Minnesota’s high risk pool, for example, was funded by a mix of revenue from premium payments, taxes on insurance companies, and the occasional state subsidy.

Minnesota’s high-risk pool, before Obamacare took effect, was considered successful: it was affordable, and with roughly 26,000 enrollees, contained one-sixth of all high-risk pool members in the U.S. (Other states had low enrollment due to high monthly premiums.)

High-risk pools have been prominent parts of Republican ideas for replacing of Obamacare, but House Republicans moved to shore them up in the AHCA with additional funding. Michigan Rep. Fred Upton introduced an amendment to provide $8 billion over five years from the federal government specifically to shore up high-risk pools in the states.

Beyond that $8 billion, states would have $130 billion spread out over a decade to stabilize insurance markets in the states, but they can do so in seven ways, only one of which is by funding high-risk pools.

So, can high-risk pools rescue people with pre-existing conditions from the problems posed by waiving community rating?

Ultimately, it comes down to how adequate the source of funding for high-risk pools turns out to be. To many experts, the AHCA falls short here.

Even if states use that $138 billion entirely for the purpose of relieving premium costs for sicker patients — which is not a guarantee, experts say — that comes out to $13.8 billion a year over ten years.

Another complication here is that the effectiveness of the money depends on how many states get waivers. If it’s two, the $8 billion in Upton’s amendment will go a long way; if it’s 30, not so much.

Proponents of the law could not provide a concrete answer to what would happen if many states opt to share a piece of a pie that’s a set size. “My guess is this is an experiment in fiscal federalism,” Lewis said.

Paulsen told MinnPost that, if this initial source of funding proves inadequate, “additional monies can be added… in two years, when appropriations are going, if it looks like we need to shore up a risk pool here, things will balance out.”

(Fiedler was skeptical of this reassurance: “If Congress were committed to providing adequate financing,” he said, “it could have written the AHCA in a way that would automatically provide the amount of funding that actually turned out to be required, rather than just setting an arbitrary dollar amount.”)

How much money would the feds realistically need to put into an insurance market that effectively covers those with pre-existing conditions on the individual market? Health care analysts have put forth varying estimates, and $15 billion a year is essentially the floor.

“We’re talking in tens of billions of dollars a year,” Fiedler says, saying the $8 billion over five years allocated in the House plan is “a drop in the bucket.”

If the federal subsidies don’t adequately fund insurers’ cost to cover high-risk individuals, they will simply raise premiums.

Others have pointed out that even a minor reduction in premiums may not be enough for older, lower-income people — those who are widely considered the losers in this bill. Washington and Lee’s Jost writes that “the reduction in premiums that would result from the program is unlikely to be sufficient… given the fixed-dollar, age-adjusted tax credits offered by the AHCA.”

What it means for Minnesota

Would Minnesota apply for a waiver, if the AHCA in its current form were to become law? Some doubt that a Democratic governor like Mark Dayton would apply to waive Minnesota from essential health benefits requirements.

But others say it is hard to anticipate how state leaders will react, and argue that their decisions may rest more on the particulars of the insurance market in their state rather than on ideology. (Plenty of red-state governors applied for the Medicaid expansion under Obamacare, after all.)

Indeed, Wisconsin Gov. Scott Walker — no fan of Obamacare — initially suggested support for the waivers, but quickly walked that support back in an argument with a Democratic county official last week.

According to the Kaiser Foundation’s Claxton, though, the financial pressures could win out: “I think we can expect that, for affordability reasons, states will take the waivers to reduce benefits… so that people with pre-existing conditions can be segmented out for some period of time.”

Lynn Blewett, a health care and insurance expert at the University of Minnesota, says that though Minnesota’s high-risk pool worked reasonably well before the ACA, replacing the law would not simply return things to the way they were before it took effect.

If the AHCA were to go forward, in Minnesota, the “high-risk pool is likely going to have a pretty high premium,” Blewett says, adding she isn’t sure how backers of the AHCA claim that those with pre-existing conditions are protected.

For now, the AHCA is far from being law. For it to advance, it must be taken up by the Senate, where Democrats hate the bill and even Republicans have some significant reservations with it, particularly its deep cuts to Medicaid.

House Republicans don’t claim this is a perfect bill, and expect it to be tweaked and adjusted as needed after it passes — something Democrats planned to do with the ACA before losing their congressional majority.

Republicans acknowledge, though that they still have some selling to do to the general public. Recent polls find that fewer than one-third of Americans support the GOP’s bill.

Lewis bemoaned to MinnPost what he called the “partisan demagoguery” surrounding the AHCA and its critics’ claims, such as the later-debunked claim that it classifies rape as a pre-existing condition.

It’s not the sensational kinds of claims that give experts pause, though — it’s the hard math. “I think it’s fairly hard to square what’s been said about the bill,” Brookings’ Fielder says, “with the analytic reality.”

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Comments (25)

Follow the money

“…Lewis bemoaned to MinnPost what he called the “partisan demagoguery” surrounding the AHCA and its critics’ claims, such as the later-debunked claim that it classifies rape as a pre-existing condition.” It's more than a little hypocritical of Jason Lewis to "bemoan the partisan demagoguery” surrounding the AHCA given the level of partisan demagoguery that surrounded (and continues to surround) the ACA. Rumors that rape would be classified as a preexisting condition are no more far-fetched than were the rumors about "death panels" that swirled around the ACA. I've never listened to right-wing radio, so I don't know whether Lewis personally supported the "death panel" meme or not, but it was very popular among many others who like to call themselves "conservative."

Health insurance companies don't care about my health—or yours. Like every other corporation in the capitalist society we call the United States, they exist only to make money for their investors. The more they have to pay out in benefits (health), the less money they make. The corporate means of dealing with that situation is to A) limit coverage, so they pay out less; B) raise premiums, so their income exceeds what they have to pay in benefits; or C) some combination of the two. Even with good intentions that I generally don't assign to Paul Ryan or today's Republicans in general, it's not hard to see in the AHCA as proposed a lot of support for C).

Just as important, and a part of C) above, is the idea contained in the AHCA of getting rid of the individual mandate. Without that, there's no way to avoid falling back to the pre-ACA days where those who are healthy don't need insurance, and thus don't buy it, while those who DO need health benefits to help them survive an illness or injury financially simply cannot afford it. The AHCA, in practice, will be a reversion to great health care for those with plenty of money, barely adequate health care for the less affluent, and terrible health care for those whose incomes are below the median for their state or area. We'll be dropping back to the Bush administration in terms of the health care that most people can afford, and at today's prices ($250 for a 15-minute visit to the family doctor, or to get your teeth cleaned at the family dentist's) most of what's available will be out of the reach of most of us without a 2nd mortgage on the house, or, more likely, bankruptcy.

We remain the only—the only—industrial nation on the planet wherein fairly common medical expenses can literally bankrupt even the most frugal and hard-working among us. A serious illness like cancer will almost automatically mean financial ruin. That, to me at least, doesn't seem like progress, much less humane policy.

Excellent Ray

Well said Ray...excellent
I wanted to hit a like button, but there are none.

Financial ruin

For the uninsured a serious illness like cancer will almost automatically mean death.

Despite what the GOP tells you, the medical profession has NO obligation to provide care to the uninsured. When I was uninsured and had a serious illness NO Dr. would see me without cash up front. Cash I didn't have as a barely scrapping by graduate student. ER will only see and treat the uninsured for immediate life threatening things. There is no chemo in ER, no biopsies, no meds for the chronically ill.

Once I got employer sponsored it was an 80/20 plan and major surgery put me in debt for several years. The hospital just didn't believe I didn't have $40,000 (in 1993 $, 2x my annual salary) lying around my apartment so they turned me over to a collection agency. It was years of paying whatever I could each month until I paid my 20% off.

Today I have what healthy people call a Cadillac plan. My premiums are $420 a month, 15+ drugs x $35-$50 a month, ~ $100 in durable medical every other month, out of pocket $9,040 a year. Still, much cheaper than the 1000 premiums,10,000 deductible and 20% coinsurance I would have on the old MCHA plan.

I Wonder If

What you say is you're current premium of $420/month, is that your portion of the premium is $420/month, and your employer picks up an unknown amount?

Most of us have no idea what the actual premium is, we just know how much our employer asks/tells us to pay.

Feel to correct me, my kids do it all the time, and without mercy.

"access"

"Nothing in this bill would allow an insurance company to deny someone coverage, including to those with a pre-existing condition." Paulson

GOP sound bites keep saying that people with pre-existing conditions will have access to health care. I have "access" and could buy a McLaren P1 LM, sadly I don't have the $3.7 million. (most expensive car in world)

As long as insurance companies can charge people with preexisting conditions more and states can allow skimpy benefit sets, low and middle income people with health problems will not have access to care.

Minnesota's high risk pool worked for people who could afford it. Most Minnesotans couldn't.

Two legislators, who were professional insurance brokers, pushed for changes in the MinnesotaCare income limits and created the Healthy Minnesota program to offer subsidies for poor folks to buy insurance from brokers (yeah, no conflict of interest there), were "shocked" (pissed they didn't make any money off the scheme) that so many of these folks ended up uninsured. Many were denied coverage in the private market and the subsidy was too low for these folks do buy the high risk pool plan. Actually the subsidy was too low for the private market plans too.

Access to buy high priced insurance is not the same as health care.

Repubs are not being honest

"Republican backers of the bill say that their critics are blowing the pre-existing condition debate out of proportion." That is NOT TRUE.
*If you are middle aged, you will be penalized with more expensive coverage
*if you have pre-existing conditions, you will be penalized with more expensive coverage
*If you drop coverage for any reason, which could mean you don't have any money, you will be penalized with more expensive coverage when you rejoin
*24 Million people will be dropped
*Medicaid will be cut drastically
*This program will cut some funding for medicare
*The wealthy are getting a massive tax cut while we the people, are getting a horrible plan

The sad issue is that repubs knew we'd be upset, so now they're refusing to be honest. This is nothing more than a very cruel bill. Interesting that they're always talking about it is too expensive for the govt, but they always have room for massive military spending (currently uses half of our revenues) and tax cuts, for especially their wealthy financial benefactors.
They should be ashamed of themselves.

Partisan Demagoguery's a pre-existing condition

My friend was the perfecting example of a fit and healthy mature man. Tripped and fell down his stairs. Went into a coma for over a year. Got a nosocomial infection and lost (while in a coma) both his legs. Miraculously recovered from the coma, was utterly devastated by the loss of his legs and past away shortly after.

His insurance covered the whole incident. Such is the "old" concept of insurance. The new concept of a buying and insurance plan even though I don't need it is ludicrous. Who would be that stupid? You buy insurance because you might need it. It costs less because the risk pool is huge. Change the health parameters to include only a high risk pool and the costs will be astronomical. Why does congress think we are all too stupid to understand this basic element of insurance.

This all points to a single payer system with equal coverage, benefits, costs to all. Just like nearly every other industrialized country in the world. Lets quit letting the insurance industry turn loose their boogeymen in order to scare us into keeping our current disaster.

Republicancare

I suggest you start your analysis with the tax cut in the Republican bill-- estimates vary but it's likely around 800 Billion dollars over ten years. The falseness of the rhetorical tricks about coverage -- every one has access to insurance (without mentioning what it costs)--is put in stark relief once the reductions in federal spending are set out. From there, it's possible to see what's actually happening: Obamacare's federal support for the individual insurance market is being wiped out as is Obamacare's federal support for the provision of Medicaid insurance. Follow the money.

Easy answer for everyone

Besides the republicans- NO

Disingenuous

This is disingenuous: “I would say, number one, that the whole pre-existing issue does not apply to 93 percent of Americans,” Paulsen says.

Most people my age, mid fifties to early sixties, live in fear of losing jobs and employer health insurance. And nearly all of us have preexisting conditions. Keeping continuous coverage is easier said than done.

Segregating those unfortunate enough to have a preexisting condition in a high risk pool ghetto is not good business. Reinsurance should be explored instead. I have no confidence that Paulsen will raise taxes in the future to cover the certain shortfalls in funding for high risk pools. In the end, the AHCA is simply a tax cut bill.

When I first read the

When I first read the exquisitely drafted collection of sentences constituting Rep. Erik Paulsen's health care op ed in the Star Tribune, my first thought was that to write like this was why interns go to Harvard. To an amateur such as myself, the marvelous combination of truthfulness with deception presented in the document was beyond anything I could imagine. It merited the kind of academic deconstruction that scholars devote their lives in analyzing the novels of James Joyce or Henry James. I thought about writing a response to it in a letter to the Star Tribune but I was quickly overwhelmed by the complexity of the task. As it happens, Mr. Brodey has done exceedingly well in his effort to dissect, Mr. Paulsen's prose.

I would focus on just one element, the notion that access to waivers would be "strict". There simply is no point in enacting "strict" laws if they aren't strictly enforced, and there is no reason at all to think that the federal government could strictly impose their rules on the state, particularly a federal government as strongly committed as this one is, to leave states on their own. And quite frankly, as an advocate of federalism myself, there is a problem in states being dictated to by the federal government, something my Republican friends go on endlessly about in every context except this one, apparently.

Mr. Paulsen says his legislation doesn't allow exclusion of pre-existing conditions. What he wants you to hear you saying but what he doesn't want to say because it isn't true is that his legislation requires the coverage of pre-existing condition with insurance coverage that is reasonably affordable to all Americans. Reasonable coverage of preexisting conditions is the essence of Obamacare, and the thwarting is what Rep. Paulsen's bill does, and it is what his op ed piece is designed to conceal.

50% of Americans Have Pre-Existing Conditions

Nice article. Too nice. According to Centers for Disease Control, about 50% of American take prescription drugs. Pre-Obamacare experience experience tells us this is the how insurance companies will define Pre-Existing Conditions. This means 50% of Americans will go into the High Risk Pool. The expected results under the Trump/Upton Health Care Proposal are not nearly as uncertain, or as sanguine, as this article implies.

Trust them...

A bunch of guys who are willing to risk the lives and well being of 8% of the population (that's 26 million people by the way) on an "experiment" in fiscal Federalism can be trusted to expand federal expenditures... if need be.

Meanwhile they tell you that the difference between being denied coverage and being priced out of coverage is: "Huuuuuuuge". So when you end up without coverage you can take comfort in the fact that the insurance company didn't actually drop you, they just raised you're rates beyond the point where anyone who actually needs insurance could possibly afford it. And again, don't worry, we'll have a pool for you to swim in and a bunch of small givment guys who have done nothing but cut spending and taxes for 50 years promise to pump more money into health care, because pumping more money into government programs is what these guys are all about.

And by the way, the answer to the question is: "Not"

Maybe I missed it but I didn't see an actual answer to the question: "Does this bill maintain protection or not?". The answer is no, it does not maintain protection, it put's 26 million people at risk of losing their insurance and it guarantees that millions will end up without insurance because they can't afford premiums and won't be able to get into the high the inadequately funded high risk pools. This bill also guarantees that millions of Americans will end up back on insurance policies with deadly coverage holes with exorbitant deductibles and co-pays, and those will be people who can get insurance.

your last sentence

described the result of the ACA for millions...ACHA is far from perfect, but lets not pretend the ACA is either...

Att's why...

Sanders is talking about Medicare For All.

Pre-Ex

The trade off for the ACA's pre-exisitng inclusion guarantee(individual plans only) is to have an open enrollment period for coverage effective January first (some, including MNsure, extend the open enrollment as far out as 3/1). If you don't apply during open enrollment you are denied coverage under the ACA unless you have a special enrollment event ( loss of employer coverage, divorce,etc.) This keeps folks from gaming the system and only buying coverage when they get sick. Good move when ACA was crafted.

The ACHA throws a wrinkle in it (not sure if it will apply everywhere though), if you don't buy coverage during open enrollment and get sick, you can buy coverage any time with a 30% rate up. So, you are not denied like the ACA would do, but you pay extra for a year. Not sure how functional that idea is, it seems folks can still game the system for a short term penalty, or not be able to afford the added premium.

It is completely misleading and wrong to say under the ACHA everyone who has ever taken a med will now be denied insurance or thrown to the curb to die because of a pre-existing condition.

I'll bite

" It is completely misleading and wrong to say under the ACHA everyone who has ever taken a med will now be denied insurance or thrown to the curb to die because of a pre-existing condition."

Please: Show the text,

Thanks
Devils advocate perspective/ actually undecided/ healthcare is way expensive, now, is the new one cheaper and better? Devil you know vs the devil you con't know.
How many people are we willing to let die (kick to the curb) in order for my rates to drop, and of course the rich get richer, at the expense of those kicked to the curb? i.e. Where do we draw the line on our humanity?

A trillion dollars

Looking at things in it's most basic way, what Congressman Paulsen is trying to do is take a trillion dollars from health care and move it somewhere else, mainly tax cuts, which will largely benefit his wealthy contributors and his wealthier constituents.

What happens when that trillion dollars goes missing from health care? Do Americans receive a trillion dollars less in care? On whom is the burden of the trillion dollars loss of care imposed?

The answer to the first question is a soft no. Other stakeholders will make up at least a portion of that loss, In will show up on different lines of the federal budget causing the deficit to rise. Health care professionals will absorb a part of that when they will be asked to perform their services for free or for reduced costs. Some people will be denied care or simply unable to find a way through the bureaucracy to receive it. No one knows how this will work in practice. The system will be, using Congressman Paulsen's word, "flexible".No one knows whether there will be any cost savings derived from the policy, both because people will for various reasons be pushed into more expensive forms of care, but also because the costs of what Congressman Paulsen is advocating will be more difficult to assess. T

The negative

The point of the ACHA is that it introduces flexibility into health which has the effect of introducing uncertainty in markets that are already nervous, unstable, and subject to liquidity. After years of complaining that Democrats had passed a bill without know everything that's in it, the bill Congressman Paulsen supports has unpredictability as virtually it's defining characteristic. Congressman Paulsen what the states will do under the ACHA, but what he is sure of, is that whatever the states do, he doesn't want to be held responsible for it. And one thing I am pretty sure of is that in politics, it's never a good idea for voters to support any effort by any of their elected representatives to let themselves off the political hook. It can be ok for politicians to shift power, but it's never in the interest of voters to allow them to shift responsibility.

The wierd

In today's Star Tribune, 744,000 are mentioned as the number of people with a pre-existing conditions in Minnesota. The 26,000 is misleading for those of us who cover are own pre-existing conditions (1 doctor's visit and lab test per year and daily medication paid out of my own pocket.) The ACA saved us 4000 per year in insurance cost when we were all placed in a community pool versus rated risk pools by insurance companies. We have a son who 10 years ago had no requirement to have insurance. He had a serious car accident. The medical bills exceeded 250,000. He declared bankrupcty. It's hard to believe we don't have the common sense to understand that everyone needs health insurance.

Pre existing

The question has an obvious answer - No unless they are also rich. The second take away is that the GOP does not care, they simply want to get rid of President Obama's program to extend health care like all the other Western Nations to our citizens.

The original bill needed updating, changes, like all major initiatives, but this was about removing the legacy of an African American president and it is shameful.

Nice observation

Hate to say it but has the smell, feel and taste of reality. Racism alive and well in America.

Obvious "no"?

Yes, the answer is obvious, but then what's the point of the article? The title implies that the answer isn't obvious, doesn't that obscure rather than inform? And since the answer is obvious, why not clearly state the answer?

This is the problem with "objective" style reporting, and frankly I'm little disappointed to see it on Minnpost. The "objective" refusal to draw an obvious conclusion creates the impression that there is no obvious conclusion. Sure they say:"well we'll let the reader draw their own conclusion" but you have to go out of your way to write an article that pretends that there is no obvious conclusion, and that requires presenting alternative facts, like Republican's denying the truth. Why do that? It isn't necessary to cover the story. You could write article around the Republican claim that their legislation preserves coverage for pre-existing conditions, the title could be: "Minnesota Republicans Claim That Coverage Will Be Maintained" or something like that. Then you explore the claim and reveal it to be a false claim- that's the real story, and it's a story that needs to be covered by responsible journalism.

The story here, and we need to be clear about this, is that Republicans are once again stomping on the weakest and poorest among us, throwing millions out of health insurance; AND Republicans are lying to the American people when they deny what they're doing. THAT'S the story, and there's no good reason to obscure it.

In the old days media framed stories this way because they didn't want to directly challenge power for a variety of reasons. However few of those reasons were good reasons and our society and political landscape suffered because critical issues and facts were obscured rather than clarified and revealed.

public benefits get lined with procedural landmines?

Seems the "keep insurance going" provision is designed to trip up people who - through confusion, or lack of means, or inability to act in timely fashion - will fail to keep continuous coverage per the new regulations. I have a social sciences PhD, my daughter an MD, my son a BS Business, my gf a BA plus financial planner certification. Together we had one "heck of a time" navigating MnSure when it was first launched (euphemistic, as carpet- F-bombing was deployed regularly ). It remains more complicated than is reasonable to ask informed citizens to navigate today, to my take. Yet, the Congressional Republican plan makes the current law seem simple by contrast.

Congressional Republicans seem to have designed a system intended to trip up citizens through complexity, which those Republicans will then blame citizens for failing to navigate successfully. And a whole bunch of people will have "access" to insurance they can not possibly afford. Meanwhile France insures everyone .... and at 1/2 of the cost per citizen that we pay in the US for incomplete health coverage. Why are the French so much smarter than Americans on how to organize health care for citizens?