Health law vow revives talk of high-risk pools
How to cover those with pre-existing ailments a concern.
Jo a nne F i t z ge r a l d was getting divorced and was stressed out. When stomach pain kicked in, she saw a doctor to have it checked out. That was her mistake. The doctor diagnosed a mild form of gastritis, an inflammation of the stomach lining, and recommended some over-the-counter medicine.
B u t whe n t h e d i v o r c e became final, in 2008, she lost health coverage from her husband’s employer, and insurer after insurer refused to cover her because of the condition. She was finally offered a policy that excluded coverage for anything related to her gastrointestinal tract.
“I thought I was being smart in going to the doctor and getting checked out,” Fitzgerald, 55, who lives in Washington, said recently. “Then I tried to go get insurance and everyone denied me.”
Her f o r t u n e s c h a n ge d under the Affordable Care Act, which required insurers to cover pre-existing medical conditions.
She was one of the millions of people who jumped at the opportunity and bought a policy available under the new law.
Now, after President Donald Trump and the Republican-controlled Congress have vowed to repeal and replace the health law, one of the most vexing questions is whether people like Fitzgerald will be covered.
About 27 percent of people younger than 65 are thought to have some sort of pre-existing condition that will most likely leave them without individual insurance if the law is repealed, according to a recent study. The guarantee of coverage has already become a rallying cry for people who want to keep the law.
Before the law, a fairly typical life event — like the loss of a job — and a relatively minor medical condition could upend a person’s health coverage options. Stories of sick people unable to get coverage when they needed it most were legion.
Trump insists he wants to keep the pre-existing requirement for insurers, and other top Republicans say people who want coverage should not be turned away. Details about how they will cover people with existing medical conditions have not yet emerged, but many lawmakers have started pushing an idea — known as high-risk pools — that left many people uncovered or with strict limits to their coverage in the past.
The challenge for lawmakers is this: How do you get insurers to cover people who will definitely need costly medical care — and do so without making insurance too expensive for everyone?
The Affordable Care Act addresses that question by requiring everyone to get coverage or face a penalty.
Top Republicans, though, say the system is not working and point to double-digit price increases for premiums.
“There is a better way to fix that problem without giving everybody else all these massive premium increases,” the House speaker, Paul D. Ryan, said at a recent televised forum.
Finding a fix is far from simple.
The high-risk programs offered a separate insurance pool for people with potentially expensive medical conditions.
The idea is that by separating sick people from the maj o r i t y o f p e o p l e who are healthy, insurers could offer cheaper rates to the healthy people. Insurers could charge higher prices to those with existing medical conditions, but they would also rely on other sources of funding, from the government or elsewhere, to cover their costs.
In many cases, the highri sk pools were overburdened financially, leaving many people without insurance or with tight restrictions on coverage. Insurers refused to cover the individuals who were likely to have the highest expenses, like those who had HIV or serious kidney disease, and the pools lost money.
Many states had to turn applicants away — in some states, only a small percentage of those who applied received coverage — and the insurance was sharply limited to control spending. a short time later.
“Watched protests yesterday but was under the i mpre s s i o n t h a t we j u s t had an election! Why didn’t these people vote? Celebs hurt cause badly,” Trump tweeted early Sunday morning. Ninety-five minutes later, he struck a more conciliatory tone.
“Peaceful protests are a hallmark of our democracy. Even if I don’t always agree, I recognize the rights of people to express their views,” the president tweeted, still using his personal account.
The dueling tweets marked hi s administration’s first response to the more than 1 million people who rallied at women’s marches in Washington and cities across the world. Hundreds of protesters lined the street as Trump’s motorcade drove past on Saturday afternoon, with many screaming and chanting.
T h e Wash i n g t o n r a l l y appeared to attract more p e o p l e t h a n a t t e n d e d Trump’s inauguration on Friday, but there were no c o mpl e t e l y c o mpar a b l e numbers. Regional transportation officials tweeted on Sunday that 1,001,616 trips were taken on the rail system on Saturday. Metro spokesman Dan Stessel had said that on Friday, the day of Donald Trump’s inauguration, just over 570,000 trips were taken on the rail system.
Even suggestions of weak enthusiasm for his inauguration clearly irked the new president, and appeared to knock the White House off its footing as it took its earliest steps.
On Sunday, Trump’s spoke with Israeli Prime Minister Benjamin Netanyahu, who accepted an invitation to vi s i t t he White House i n early February. Trump also announced that he’s set up meetings with the prime minister of Canada, Justin Trudeau, and Mexican Pres- ident Enrique Peña Nieto.
“We’re going to start some negotiations having to do with NAFTA,” he said of his meeting with Mexico, along with immigration and security at the border. Trump has promised to build a wall along the length of the southern border and insisted that Mexico will pay for it.
White House chief of staff Reince Priebus said on “Fox News Sunday” the president would spend his first full week in office undoing some of his predecessor’s agenda and planned to sign executive orders on immigration and trade.
Trump has pledged to scuttle trade deals such as a pending Asia-Pacific agreement and overturn Obama’s executive order deferring deportations for 700,000 people who were brought into the country illegally as minors.
Trump plans to meet today with a bipartisan group of congressional leaders to discuss his agenda.
Later in the week, he’ll a d d r e s s c o n g r e s s i o n a l Republicans at their retreat in Philadelphia and meet with British Prime Minister Theresa May.
In talk show interviews Sunday, Trump’s advisers defended his criticism of j our na l i s t s f o r c o r re c t l y reporting that his inauguration drew a smaller crowd than Obama did eight years a g o , s a y i n g t h e T r u m p administration was supplying “alternative facts.”
“There’s no way to really quantify crowds. We all know that. You can laugh at me all you want,” Kellyanne Conway told NBC’s “Meet The Press.” She added: “I think it’s actually symbolic of the way we’re treated by the press.”
Aides also made clear that Trump will not release his tax returns now that he’s taken office, breaking with a decades-long tradition of transparency. Every president since 1976 has released the information, but Trump has said he doesn’t believe Americans care whether he follows suit.
Throughout the campaign, Trump refused to make his filings public, saying they’re under audit by the Internal Revenue Service and he’d release them only once that re v i e w i s c omplete. Tax experts and IRS Commissioner John Koskinen said such audits don’t bar taxpayers from releasing returns.
“He’s not going to release his tax returns. We litigated this all through the election. People didn’t care,” Conway said on ABC’s “This Week.”
Trump, whose 12th wedding anniversary was Sunday, also attended a reception for law enforcement officers and first responders who helped with his inauguration. He singled out the work of FBI Director James Comey, whom he offered a handshake and hug.