Trumpcare is great if you're not all fixated on 'tooth retention.'

As part of Team Trump's never-ending quest to undermine the Affordable Care Act, the Department of Health and Human Services has released a proposed rule to offer cheap crappy short term health insurance policies that save money by not covering benefits required under Obamacare. Yep, Trump is bringing back "junk insurance" for all those people who were disgusted that Barack Obama took away their policies that cost relatively little because they covered practically nothing. Let's take a look at what the new rules would allow, at least once HHS ignores the results of the public comment process.

To our ears, the biggest gut punch of the new rules is that they would -- again, just like the bad old days -- allow insurers not only to charge more for people with pre-existing conditions, but would also let them impose annual caps again. Oh, did they spend too much on your chemo? Well, that was probably enough chemo for you.

As we discussed when Donald Trump signed an executive order that led to these rules, since the whole point of the ACA was to get as many Americans as possible enrolled in real health insurance, Obama's HHS cracked down on short-term insurance policies in 2016. Short-term insurance was limited to three months' duration, so people who might need interim coverage could get it, but most people would be nudged into the individual plans on the exchange.

In effect, the new HHS rules would reverse that, allowing plans that stay in effect for 364 days (longer "short-term" plans may eventually be in the works). The plans wouldn't have to cover the suite of essential health benefits covered by real insurance, so they could exclude needless luxuries like emergency services, preventive care, prenatal and maternity care, mental health coverage, and of course contraception, which is of the devil. Heck, the policies wouldn't even have to cover hospital stays. The ACA's protections for people with preexisting conditions also would not apply, so insurers could jack up your rates or just plain deny coverage for whole categories of care. (For instance, in the bad old days, one policy I had excluded all coverage for skin problems, including skin cancer, because I'd once seen a doctor when my fingers got dry and cracked in the winter. That was some pricey hydrocortisone cream!)

Seema Verma, the head of the Centers for Medicare and Medicaid Services, touts the plans as providing "a much more affordable option for people in need,” which sounds very nice until people buying such stripped-down coverage find out their emergency room visit is an out-of-pocket fee.

The other goal here, of course, is to make plans on the exchanges even less affordable for older, sicker patients, who need to be punished. Siphoning off young healthies to lower-cost plans takes them out of the ACA risk pool, so premiums will have to go up to meet the higher costs of care. Like the repeal of the individual mandate in the Tax Cut bill and the other part of Trump's executive order, those "association health plans" he got so inarticulately excited about a while back, this is yet another assault on the crazy idea that everyone should have basic coverage to spread out the costs for those who need it most. You see, the whole idea of distributed risk is actually socialism (or, as some call it, "how insurance works in the first place").

These rules are, as we say, subject to public comment before they can become law. Let HHS know you support the ACA and don't want to see it undermined: You can read the rule here and submit a comment at Be sure to refer to "file code CMS-9924-P." Public comments must be received no later than 5 p.m. Eastern time on April 23, 2018.

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[Vox / Healthcare Dive]

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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