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It's BAAA-A-A-ACK. Like a hideous hell-spawned beast in a horror movie, the Republican plan to repeal and "replace" the Affordable Care Act simply refuses to die, returning in ever more gruesome forms as it's shocked back to life by rightwing Republicans who just know in their hearts that America wants fewer people to have health insurance. And like any eldritch abomination sewn together from rotting corpses and campaign promises, the latest version would be toxic to all that is good and healthy, offering states the option to opt out of essential health benefits and even to ditch the much-promised provision that preexisting conditions would still be covered. No surprise there -- reanimated corpses always have parts dropping off them.

After giving up on Obamacare repeal a bit over a week ago, the mad scientists are back in the lab, tinkering with forces they simply don't understand, but promising the resulting beast will be gentle as a kitten. Or a kitchen, maybe. And will you just look at the shambling horror the House Freedom Caucus would like to unleash this time around:

The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

The great thing about getting rid of that, though, is that nobody knows or cares what "community rating" is, plus doesn't "community" sound dangerously like "communist" anyway? Let the free market decide!

Dropping the essential health benefits would do wonders for bringing insurance prices down, since it would allow the return of good old "junk insurance" plans, which are plans that are junk, not necessarily plans that cover your junk -- no requirement for maternity or reproductive health care any more. This would present consumers with a terrific false sense of security, since as the New York Times notes, "A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs." But if it covers aromatherapy, you might do just as well. Maybe.

The real evil genius of the Freedom Caucus plan is that it would allow Republicans to say they've retained the ACA's provision protecting people from being denied coverage for preexisting conditions, since insurers would still be barred from denying coverage altogether. Eliminating the community rating requirement would simply leave insurers free to charge whatever they want for such coverage. Being priced out of coverage is very different from actually being denied coverage, isn't it?

If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.

But just think of all the campaign ads with happy consumers praising their representative for letting them buy really cheap "insurance" again! And that would be a really great thing for young healthy people who have no idea how insurance works in the first place, except it wouldn't really be "health insurance." So, if we got rid of those parts of the ACA, what would our wonderful new innovative healthcare marketplace look like?

We do not have to speculate to know what the world looks like without essential health benefits and community rating. It was how most state insurance markets worked before Obamacare. Back in 2009, most sick people who did not get insurance through work or a government program were excluded from coverage if they had a history of health problems like allergies or arthritis. Plans that did not cover pregnancy care or drug addiction treatment were widespread.

But people could still go to the Emergency Room, so everyone was in great shape, and the costs of those uncovered ER visits magically never affected anyone, as long as you hummed real loud when healthcare economists explained that's one of several reasons why healthcare costs were always increasing.

And how quickly would the Freedom Caucus like to roll out this new and even crueller version of Obamacare repeal? Real darn quick, according to Freedom Caucus leader Mark Meadows:

Why would you want to know how many people would lose coverage before you vote on this thing? People having the choice to lose coverage is what this is all about, after all, so it's wrong to say they'd "lose" coverage -- they'd simply choose to do without, because they're young and healthy and will never choose to have a medical emergency, choose to get hit by a bus, or choose to grow old, duh. And if something bad happens, well, then, they can always go to the ER.

Which will be staffed with members of the House Freedom Caucus, voting to free hospitals of the burdensome requirement to treat uninsured people at the E.R. (that's your horror movie twist ending. SCARY!)

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[NYT / HuffPo / WaPo]

Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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