High-risk pools are never good

I am far from an expert on (or even super knowledgeable about) health care, so I’m not exactly speaking ex cathedra here, but this to me seems like the perfect example of idiotic and deeply cruel Republican non-governance.

WASHINGTON — House Republican leaders planned to hold a showdown vote Thursday on their bill to repeal and replace large portions of the Affordable Care Act after adding $8 billion to the measure to help cover insurance costs for people with pre-existing conditions…

Democrats and health care groups tried to slow that momentum. The liberal health advocacy group Families USA said another $8 billion would do little to improve the “high-risk pools” that could be set up by states to provide coverage to people with pre-existing medical conditions who could not find affordable insurance in the open market.

The American Medical Association and 10 organizations representing patients, including the American Heart Association and the advocacy arm of the American Cancer Society, reiterated their opposition to the House Republican bill on Wednesday, as did the retirees’ lobby AARP…

Mr. Upton and Sean Spicer, the White House press secretary, said they believed that the money in the bill would be adequate. “It’s our understanding that the $8 billion over the five years will more than cover those that might be impacted and, as a consequence, keeps our pledge for those that, in fact, would be otherwise denied because of pre-existing illnesses,” Mr. Upton said at the White House.

So, essentially, millions of Americans are counting on the math skills of Sean Spicer.

Basically, the new and improved ACHA was dead in the water because it basically did away with the pre-existing condition clause, the single most popular part of the increasingly-popular Obamacare, but then an amendment was passed that set up $8 billion dollars of 5 years to subsidize state-run high-risk pools. The thinking is that if you can’t get insurance because you are sick, you can go into these pools.

Of course, virtually nobody thinks coverage in those pools will be adequate. There isn’t enough funding, and by definition, they lose money. The pools are small and there aren’t enough healthy people in them. They are a second-class stopgap, at best.

But let’s say reasonable people can disagree! Let’s say that Upton and Spicer, and the rest of the GOP, which seems increasingly swayed to voting for it, are convinced this will be an acceptable substitution. After all, Upton said it is his “understanding” the $8 billion will be enough, and if that’s good enough for him, it’s good enough for us!

Even with that, one could maybe step back, and say: what? Because, to break this down, they are hoping that the money they spend will be enough to provide mediocre insurance to the very sickest as a way to not-really-solve a problem that they created in the first place by doing something nobody wants.

This, then, is the rockiest shoal of ideology, on which the dreams of a thousand AM radio hosts and a million /r/ commentators get dashed upon reality.  They “have” to repeal Obamacare, since it is the biggest assault on freedom and personal liberty since seatbelts. But it is also popular, and when it comes to pre-existing conditions, super popular, because all except the very worst don’t think that the profit of private corporations should take precedence over an individual’s health (and yet, people still vote Republican). But you can’t really repeal Obamacare and keep pre-existing conditions, because the architecture to make sure that works is, essentially, Obamacare.

So here’s a solution! DO the terrible thing, and hope that the thing you do to mitigate the terrible thing almost sort of works. Compassion. Leadership.

But that’s what the House Republicans want. They want to pass this so they can keep their pledge, and they want to give Trump a win so he doesn’t tweet mean things about them, and they desperately want the Senate to reject it so the country doesn’t rise up as one against their perfidy, greed, and stupidity. And they know they are being perfidious, greedy, and stupid. But there’s nothing they can do about it. They are ideologically trapped, bunkered in by a decade of maximalist rhetoric.

It’s also deeply cynical. With the Upton amendment, they are praising themselves for not really solving a problem they created, and are hoping voters buy it (but really hoping it doesn’t become law). I don’t think it will pass the Senate, but there is a chance it does, because they have some of the same ideological pens the House does. And then Trump will (probably?) sign it. And we’ll have a scenario nobody wants, because these jokers couldn’t even bring themselves to discuss the possibility of fixing Obamacare.

Incidentally, the AMA isn’t impressed.

CHICAGO – American Medical Association (AMA) President Andrew W. Gurman, M.D., issued the following statement today about proposed changes to the American Health Care Act (AHCA):

“None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill – that millions of Americans will lose their health insurance as a direct result of this proposal.

“High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all.

“Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”

Yeah, but Chicago? Kind of sketchy, no? WAS REVEREND WRIGHT PULLING THE STRINGS?