UPDATED: Senate Dems put GOP on the spot re. #PreExistingConditions w/ #ShortAssPlans vote

2018 MIDTERM ELECTION

Time: D H M S

 

I first wrote about this back in March, when Wisconsin Senator Tammy Baldwin (D) introduced a new bill:

U.S. SENATOR TAMMY BALDWIN AIMS TO BLOCK PRESIDENT TRUMP’S PLAN TO ALLOW INSURERS TO SELL JUNK PLANS WITH LEGISLATION TO GUARANTEE PROTECTIONS FOR PRE-EXISTING CONDITIONS

“The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

WASHINGTON, D.C. – Following the Trump Administration’s recent proposed rule allowing insurance companies to once again sell ‘junk’ health care plans, U.S. Senator Tammy Baldwin today announced new legislation to block the rule and guarantee protections for people with pre-existing conditions.

“As someone who was branded as a child with the words, ‘pre-existing condition,’ I want to make sure that no parent, foster parent or grandparent has to choose between helping their child get better or going bankrupt,” said Senator Baldwin. “Republicans pushed repeal, but promised they would protect people with pre-existing conditions. The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

First reported in Vox, the Fair Care Act would prevent greater access to short-term, junk plans, safeguard current protections for those with pre-existing conditions and help prevent further premium increases and insurance market instability caused by the Trump Administration’s sabotage. The legislation would prohibit Trump’s proposed rule expanding access to short-term, limited duration plans from taking effect and would implement protections to ensure that short-term plans are only offered in limited circumstances as well as newly require these plans to comply with basic consumer protections.

According to the Vox article:

Even though short-term plans would still be permitted, they could no longer escape Obamacare’s core protections. They would be prohibited from denying people coverage based on their health status or charging sicker people higher premiums; they could not have annual or lifetime limits. They would also be limited to three months by law and they would be non-renewable, as the Obama administration had decreed by regulation.

The 3-month/non-renewable limit parts are simply reverting the Short-Term, Limited Duration (STLD) plan situation back to what it's been under the Obama Administration for the past few years. The new requirements that STLDs also comply with other ACA requirements including guaranteed issue, community rating and essential health benefits, however, would basically mean there'd be no point enrolling in STLDs in the first place, even for a few months...because those requirements would likely mean premiums for STLDs would likely be pretty close to what they are for ACA-compliant policies anyway.

Normally this would've been a purely symbolic move on Baldwin's part, since there's no chance in hell that Mitch McConnell would let it see the light of day. However, thanks to the weird, wonky, obscure rules of the U.S. Senate, Baldwin found a way to sneak it through anyway:

Senate Democrats are preparing a long-shot procedural maneuver to reverse new Trump administration regulations that they say would sabotage the Affordable Care Act by expanding “junk” insurance that isn’t obligated to cover preexisting conditions.

Sen. Tammy Baldwin (D-WI) is leading the effort, introducing a resolution to unwind the Trump administration’s expansion of short-term insurance plans. Those plans are not subject to Obamacare’s rules for preexisting conditions or essential health benefits and Democrats dismiss them as “junk.”

“It is sabotage, in my mind, against the guarantees for preexisting conditions,” Baldwin told me and other reporters on Tuesday. “These policies aren’t worth the paper they’re written on.”

Baldwin is doing so under the purview of the Congressional Review Act, which gives Congress the ability to reverse federal regulations within a certain time window. The odds of Baldwin’s resolution bearing fruit are long: The House would have to pass the same resolution, and President Donald Trump would have to sign a measure unwinding his own administration’s agenda or there would need to be a veto-proof majority.

If I'm understanding this correctly, the only reason Baldwin's bill will receive a floor vote over McConnell's objections is because it was written specifically in response to Trump's executive order removing Obama's restrictions on STLDs in the first place. It's still symbolic, of course, since even if it passed the Senate, it'd never make it through a GOP-controlled House, and even if it made it through that, it'd be instantly vetoed by Trump.

Even so, as I noted last month:

Baldwin's bill is a perfect way of putting the GOP in a bind over their hypocrisy on the pre-existing condition issue (well, it would be if they had the slightest bit of shame or self-awareness, anyway). If they really believe no one should be denied coverage for having a pre-existing condition, they'd be all for reining in or outright eliminating so-called "short-term, limited duration" plans...as well as any other type of healthcare policy which can discriminate against people based on their medical condition, for that matter, including "Health Sharing Ministries" and even pre-ACA "Grandfathered" and "Transitional" policies.

Of course, they don't actually believe that, or else they'd either a) NOT vote over and over again to repeal the ACA or b) would have come up with their own alternative which does truly protect people with pre-existing conditions...which, of course, they haven't.

This is hardly surprising. Covering people with pre-existing conditions costs a buttload of money no matter how you slice it. The best way to mitigate that cost is to spread it as widely and evenly as possible, via the largest and most stable risk pool you can. The ultimate example of that, of course, would be a single risk pool with all 320 million Americans in it...and the most obvious variety of that would be...wait for it...Medicare for All or similar.

So, the GOP has once again painted themselves into a corner: They keep trying to square the circle on healthcare coverage and costs, but there's no getting around it: If you want to cover everyone with pre-existing conditions, it's gonna raise the cost of healthcare quite a bit. That means someone has to pay for it all. If you further pledge not to dump those costs onto the individual enrollees, that means the government has to pay for the bulk of it...and that means raising revenue, generally in the form of higher or new taxes. The GOP refuses to do that (and in fact just slashed taxes by a whopping $1.5 trillion over the next decade for not particularly good reason), so they're left with...not covering pre-existing conditions.

...all of which brings me to this week:

Democrats are planning to force a vote in the Senate this week on overturning a Trump administration rule expanding non-ObamaCare insurance plans.

The Democratic resolution, which will likely get a vote on Wednesday, would overturn a rule finalized in August that expanded the availability of short-term health insurance plans.

Democrats decry the plans as “junk” insurance because they does not need to cover pre-existing conditions or follow other ObamaCare rules. Republicans argue the plans provide a cheaper option alongside ObamaCare plans.

The resolution, which is supported by all 49 Senate Democrats, is unlikely to pass given that it would need 51 votes, although GOP Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine), who broke with their party on health care last year, have not publicly said how they will vote.

Murkowski might vote for it. Collins...well, after her latest Lucy-pulling-the-football-away-from-Charlie-Brown stunt with Brett Kavanaugh last week, let's just say I'm not exactly holding my breath over the odds of her voting for it. Then again, as I said, it'd be a symbolic vote either way, so she might go ahead and vote for it just to try and repair her image a bit (note: it won't work).

UPDATE: Welp.

Murkowski tells reporters she won’t support Baldwin health care resolution tomorrow. Collins is undecided. Hard to see how Dems pick up two Republicans to try to overturn Trump short-term rules reg.

— Jennifer Haberkorn (@jenhab) October 9, 2018

Even a failed vote, however, would allow Democrats to hammer Republicans on the issue of pre-existing conditions, which they have made central to the campaign ahead of next month’s midterm elections.

...which, let's face it, is pretty much the only reason to have this vote in the first place: To put them officially on the record less than 4 weeks before the midterms.

As for the Trump Administration, they've already made their feelings pretty clear (to no one's surprise, seeing how it's Trump's own order which the bill would be reversing, after all):

The White House has just issued the first veto threat of the Trump administration.

It's on a resolution of disapproval for regulations that would expand short-term health insurance that was touted as an alternative to Obamacare. pic.twitter.com/o1AtXMdQuX

— Gregory Korte (@gregorykorte) October 9, 2018

UPDATE 10/10/18: And there you have it...in the end it failed by one vote: Murkowski voted no, but as I speculated, Susan Collins did vote yes, not that it'll do her any good in 2020.