Almost a fortnight ago, brief, blissful respite from our national healthcare struggles seemed to be upon us. The White House and the House GOP leadership had capitulated and agreed that the disastrous American Health Care Act (AHCA) could not even garner enough Republican votes to pass the House. Early on a Friday evening, this was wonderful news for all Americans, including those with behavioral health and ID/DD conditions.
Now, like a sphinx rising from its own ashes, an even more draconian version of the AHCA is being crafted by the White House and the House GOP. As before, the White House is negotiating with moderate Republican House members and with the ultra-right American Freedom Caucus. Disingenuously, the White House appears to be telling these two groups somewhat different things.
Stated in overly simple terms, the White House is trying a sleight of hand to reduce insurance premiums for those who are young and healthy at the expense of other less-advantaged groups. The areas of skirmish this week are community ratings, guaranteed issue, and essential health benefits.
Community ratings were put in place by the Affordable Care Act (ACA) to prevent any groups from becoming disadvantaged in their health insurance premiums. If community ratings were removed, then persons with disabilities, persons who are older, or even males could be forced to pay much higher insurance premiums because they are at risk of higher healthcare costs.
The White House would like to narrow the applicability of community ratings, either by allowing states to opt out, except for gender (which they apparently told the American Freedom Caucus), or only to opt out of age (which they apparently told moderate Republicans). Neither approach is sound: the former would put much greater financial burden on persons with disabilities; the latter, on persons who are older. Neither would achieve the goal of protecting persons with pre-existing conditions or persons who currently are ill. In fact, by contrast, both approaches would create financial advantage for the young and healthy.
Another topic under discussion is guaranteed issue, the ACA rule that requires insurance companies to insure everyone. The White House apparently told the House conservatives that guaranteed issue would be removed, yet told the moderates that it would be retained. Clearly, everyone deserves this protection, and it must be retained. Further, attempting to move persons with disabilities to high risk pools, where they will be at great risk of much higher insurance premiums, even if subsidy funds are provided, should not be construed as a meaningful substitute for guaranteed issue. It definitely isn't. It would advantage the young and healthy.
Essential health benefits
A third topic under discussion is removing "essential" from the ACA essential health benefits, and giving states the option to include or exclude specific benefits. If developed, this proposal could put the mental health and substance use benefit at risk, and also potentially endanger efforts to guarantee parity of these benefits. The current ACA essential health benefit helps to assure that people in different states and different locales in the United States have access to a similar package of good insurance benefits.This is a very important protection that should not be removed. Again, the young and healthy would benefit at the expense of other key groups.