Trump un­veils a health care fan­tasy


Af­ter a bit­ter sum­mer bat­tle over health re­form, Con­gress fi­nally found com­mon ground this fall, rec­om­mend­ing prag­matic fixes to sta­bi­lize prices and bol­ster com­pe­ti­tion in the in­di­vid­ual health in­sur­ance mar­ket.

So it is es­pe­cially frus­trat­ing that Pres­i­dent Don­ald Trump is choos­ing to ig­nore th­ese bi­par­ti­san pre­scrip­tions and in­stead launch a du­bi­ous health re­form of his own — one that even­tu­ally could leave con­sumers with worth­less cov­er­age and many peo­ple with med­i­cal needs un­able to af­ford tra­di­tional in­sur­ance.

The in­di­vid­ual mar­ket serves around 7 per­cent of Amer­i­cans — those who don’t get pri­vate cov­er­age through em­ploy­ers or pub­lic cov­er­age through pro­grams such as Medi­care. On Thurs­day, Trump an­nounced an ex­ec­u­tive or­der to al­low in­di­vid­ual mar­ket con­sumers to buy cov­er­age through ‘‘as­so­ci­a­tion health plans” or through in­di­vid­ual “short-term” plans that run the du­ra­tion of year. This, Trump said, will fi­nally al­low th­ese con­sumers to es­cape what he dubbed the “night­mare of Oba­macare.”

But a re­al­ity check isn’t kind to Trump’s ini­tia­tive, which has re­ceived a thor­ough drub­bing in ad­vance from re­spected or­ga­ni­za­tions such as the Amer­i­can Academy of Ac­tu­ar­ies and the Com­mon­wealth Fund. The rea­son is that the plan rests on a rep­re­hen­si­ble foun­da­tion: Some con­sumers will buy garbage health plans that are cheap up front but that of­ten pay out lit­tle when some­one de­vel­ops cancer, for ex­am­ple, or has a pre­ma­ture baby re­quir­ing in­ten­sive care to sur­vive.

The Af­ford­able Care Act, passed un­der for­mer Pres­i­dent Barack Obama, put in place con­sumer pro­tec­tions to en­sure that cov­er­age ac­tu­ally cov­ered care con­sumers might need. It also en­sured that in­sur­ers couldn’t turn away those with pre-ex­ist­ing con­di­tions or leave them only with un­af­ford­able choices.

De­spite Trump’s high-fly­ing rhetoric Thurs­day, his ex­ec­u­tive or­der isn’t in­no­va­tive in the least. It sim­ply al­lows cer­tain types of health plans to op­er­ate out­side some or all of th­ese vi­tal ACA safe­guards and, po­ten­tially, state over­sight. The plans that would qual­ify are as­so­ci­a­tion health plans (AHPs), which al­low peo­ple with a com­mon in­ter­est, such as a trade, to band to­gether and buy in­sur­ance. Short-term plans, which typ­i­cally are al­lowed to cover only a few months but could cover a whole year un­der the Trump change, also would be el­i­gi­ble.

It’s un­clear at this point how many con­sumers would seek or qual­ify for the cov­er­age. Or how soon they might have this op­tion. Still, this is a door that should not even be cracked open.

AHPs have been tried be­fore with alarm­ing out­comes. Some have been used “as a ve­hi­cle to sell fraud­u­lent cov­er­age to hun­dreds of thou­sands of un­sus­pect­ing con­sumers,’’ the Com­mon­wealth Fund re­ported. Th­ese plans also have been “marred” by a his­tory of fi­nan­cial in­sta­bil­ity, with one big New Jer­sey plan shut­ting down in 2002 and stick­ing pol­i­cy­hold­ers with mil­lions in un­paid med­i­cal bills.

But it isn’t just con­sumers who would buy th­ese plans who would be at risk. Peo­ple with se­ri­ous med­i­cal con­di­tions, mean­ing they need tra­di­tional com­pre­hen­sive in­sur­ance, could see mas­sive in­creases in cov­er­age costs. If too many healthy peo­ple bought skimpy cov­er­age un­der the new Trump plan, there wouldn’t be enough peo­ple buy­ing good cov­er­age through the ACA to spread out the cost of med­i­cal care and keep th­ese more com­pre­hen­sive plans af­ford­able. In­sur­ers would also exit.

The re­sult is that the Trump plan ac­tu­ally could cause the in­sur­ance mar­ket “death spi­ral” Repub­li­cans have been warn­ing about for years in their ACA crit­i­cism. In con­trast, Con­gress rec­om­mended so­lu­tions that would at­tract more in­sur­ers to the mar­ket. One of them, a rein­sur­ance pro­gram, is sim­i­lar to one rapidly launched this year in Min­nesota to shield con­sumers and in­sur­ers from the cost of pa­tients with ex­pen­sive med­i­cal needs.

Le­gal chal­lenges to the ex­ec­u­tive or­der are ex­pected and mer­ited. And it will take time for fed­eral agen­cies to roll out.

Trump’s plan disin­gen­u­ously sug­gests there are fast, easy so­lu­tions to lower cov­er­age costs with­out sac­ri­fic­ing care. Amer­i­cans are ill-served by pres­i­den­tial pol­icy pro­mot­ing this fan­tasy.

Heat-seek­ing tech­nol­ogy helped lead res­cuers to a lost boy via the fam­ily dogs that re­mained near him.

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