June 29, 2017

This is me, sounding the alarm as loudly as I can. Please take your attention off whatever has you distracted right now and look over here at Ted Cruz and Mitch McConnell as the health care horsetrading continues.

Axios reports that there are a lot of bribe efforts underway. An administration source told their reporter "I think we're going to pass this. I really think they'll bribe off the moderates with opioid money and then actually move policy to shore up Mike Lee and Ted Cruz."

Yes, they think they're going to hand out some opioid checks to Susan Collins, Lisa Murkowski, Dean Heller and more to shut them up while they go toward wingnut land on the deeper policy questions.

And how, pray tell, would policy move toward Ted Cruz and Mike Lee? Once again, Axios gives us some insight.

Pre-existing conditions, of course. It's always about the pre-existing conditions.

What the Cruz proposal does: It would allow any insurer selling a plan that complies with the ACA regulations to also offer non-compliant plans. Those plans would be exempt from the insurance regulations — including the ACA's protections for people with pre-existing conditions.

  • Two senior GOP aides have told me several members weren't aware the Cruz proposal would touch pre-existing conditions until Wednesday's lunch, when it was discussed. When asked whether members weren't aware of this prior to then, Sen. Roy Blunt told me, "probably not." (A Cruz spokesman insists it was never a secret.)
  • Here's how Cruz told reporters it would work yesterday: "You would likely see some market segmentation. But the exchanges have very significant federal subsidies, whether under tax credits or under the state stabilization."
  • "The exchange would quickly turn into a high-risk pool as non-compliant plans cherry pick the healthy people," said Larry Levitt, vice president of the nonpartisan Kaiser Family Foundation. While premium subsidies would help people afford coverage, the cost of those subsidies would drastically raise with the price of premiums.
  • People earning too much to qualify for subsidies "would be completely out of luck. The non-compliant plans wouldn't take them, and the exchange plans would be way too expensive."

It doesn't take much imagination to know that as soon as you allow insurers to offer plans which are "non-compliant," meaning that they can exclude pre-existing conditions, you have simply created high-risk pools otherwise known as "compliant" policies.

When you hear the Rand Pauls and Ted Cruzes of the world saying that the bill doesn't "repeal Obamacare," what they are really saying is that the bill doesn't reinstate pre-existing conditions exclusions.

You'd like to think most Senators would object, but here are a few who don't.

Senator Risch says, "What could be more American than having a willing buyer and a willing seller agree to enter into a transaction? It escapes me why people are, why there is any pushback."

Well, Senator, I suggest you do a modicum of reading about risk pools and how they work. This is not a market issue. It's a risk issue.

Senator Ron "Argle Bargle" Johnson says "the Cruz proposal needs to be paired with an "invisible high risk pool" — where sick people are subsidized directly — "so you really can fund the people who remain in that pool ...That's what I've been trying to promote the entire time. Let's separate the pre-existing conditions and the high-cost."

In case you had trouble translating from Kochspeak, Johnson articulates exactly what Cruz is trying to do. Carve away people with pre-existing conditions from everyone else and shovel them into inefficient high-risk pools.

Senator Lindsey "I don't understand heath policy" Graham is "looking at it." He thinks, however that it could be a good idea. Which means he doesn't know squat about risk pools either.

Fortunately, there are some Senators who get it, including Senators Cornyn and Alexander, who chair the committee which would ordinarily handle the bill before it ever went to the floor.

Do not be distracted. Pre-existing conditions, whether for the poor or middle class, has always been the target. It would affect employer plans too, just as it did before the ACA was passed.

Keep calling, keep making noise, be out in the streets, and polish your rhetorical pitchforks. We will win this, but it will take work and vigilance.

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