Mr. President, At Least Tell Us How You’re Going To Protect People With Pre-existing Conditions

Trump’s long-awaited health plan doesn’t seem likely before Election Day, but we could at least expect some clarity on that one pledge, right?

This newsletter has existed just about as long as Trump’s Presidency, and the earliest reference we could find to Trump saying his health care plan is ready-to-go took us back to a Washington Post story about a phone call with the President on January 14, 2017. In which the President referred to “nearing completion of a plan”, to replace Obamacare, he said then. On January 15, 2017!

So when the President signs and then touts an Executive Order last month saying that people with pre-existing conditions will be protected, we don’t think it’s too much to expect an answer to the question: How?

Let’s look at the Executive Order itself. Signed by the President on September 24 of this year. Surely there’s something in there. Starts out saying he’s all about:

[B]ringing great healthcare to the American people and putting patients first.”

Which of course is just a bunch of words, because who wouldn’t want that?

After a few pages, it comes to pre-existing conditions, where the President pledges a:

[S}teadfast commitment to always protecting individuals with pre-existing conditions and ensuring they have access to the high-quality healthcare they deserve.”

That sounds nice too. 

But then there’s a big red flag. The President’s Executive Order refers to the Health Insurance Portability and Accountability Act of 1996, in the context that it already mandated coverage for people with pre-existing conditions, years before Obamacare. So Obamacare doesn’t really deserve any credit for that.

That law is more commonly known as HIPAA. And most people know it because of its protections of patient privacy. But it was also meant to protect workers who lose group health insurance because they lose their jobs. To that end, it mandates any insurance company that sells individual plans must offer health insurance to them, even if they have pre-existing conditions. However, it does not require companies charge the same for everybody under those individual plans, as Obamacare does. And in almost all cases, premiums were far higher than in the worker’s previous group plan. As well as much more expensive in most cases than equivalent plans when Obamacare came along.

Extend that further and one might infer that Trump considers those HIPAA protections enough to say he’s sticking to his promise of protecting people with pre-existing conditions, if he ever does come up with a plan of his own. Or even a justification for why he’d still be covering people with pre-existing conditions with that alone, even if Obamacare is overturned and he replaces it with nothing.

In fact, those individual policies were notoriously expensive. Particularly hard to keep up with when you just lost your job. So easy to slip through the cracks. Also, in order to qualify, you had to have recently had and lost a job.

There were also a lot of other hoops to jump through to qualify: you must first have enrolled in the Federal COBRA plan, which allows somebody to extend the group health coverage they had at the job they just lost. The aim being to tide them over until you find another job, without having to switch to an individual policy and the sky high costs involved with that.

Oh, and one more thing: to qualify for any of that, a worker had to have active health insurance at their job for a period of at least 18 months, without a gap of more than 63 days.

Obamacare doesn’t really have those kinds of restrictions.

So in short, anybody who lost a job before Obamacare kicked in, knows how difficult and expensive it was to maintain health insurance. And if the President is pointing to what was happening in those pre-Obamacare days as a benchmark for protecting pre-existing conditions vs. Obamacare—which he is—then we likely got a real problem.

Or maybe not. Maybe there are people out there, maybe even lots of people who believe the President does have a “beautiful” health care plan up his sleeve, which he has just never revealed for some reason, with far better coverage and far lower premiums.

And if you do believe that and happen to be reading this, please do us just one little favor and ask yourself one simple question: if the President actually had such a plan, wouldn’t he be showing it off? Whether you support Trump or don’t, we can all agree the President is nothing if not a show off, can’t we?

So for that reason alone, we don’t even believe Trump supporters believe he has a plan, yet he’s banking on their willingness to believe he’ll protect them whatever his plan turns out to be. Even if it turns out to be nothing. Because he’d be re-elected by the time he’s really compelled to deliver on it. That is, if the Supreme Court overturns Obamacare in the latest Republican run at it, including doing away with protection of people with pre-existing conditions, which Trump is simultaneously fully supporting. And at that point he wouldn’t be running for anything anymore, so it really wouldn’t matter.

And we really don’t like to speculate on outcomes, especially on proposals that are kind of phantoms at this point.  But based on past performance, we can probably narrow down what the President’s up to, to 1 of 3 possibilities:

  1. Trump’s lying.
  2. The loophole. Again, whether you support Trump or not, you’ve got to agree he’s the King of the loophole. So let’s use as reference for how this might work the 3 Obamacare replacement plans Congress failed to pass during the 1st year of Trump’s presidency, even though Republicans had full control. In those plans, pre-existing conditions would’ve been protected at the federal level. But states would’ve been allowed to apply for waivers where they wouldn’t have to stick with the federal plan. Actually, they can do so now, but only if they still meet all mandated federal requirements, which includes coverage of people with pre-existing conditions. Those new plans would’ve allowed states to separate those people out into “high risk pools” without specifying how they could ever adequately be funded. And it left open the possibility states could decide to allow insurance companies to charge higher risk people more. One of the bills allowed insurance companies to offer basically any kind of coverage they wanted, as long as they also offered at least one single plan that would cover pre-existing conditions. Would that meet Trump’s criteria? Probably, because back in 2017, he was ready to sign it. Finally, Trump has also favored making cheaper plans available that do not meet federal standards, but people could opt into to save money on premiums. Once you’re in that plan, in many cases you’ve opted out of coverage if in the future you have something that’s considered a pre-existing condition. But since it was your “choice” to give up that protection, Trump wouldn’t exactly be lying now would be?
  3. The technicality. Insurance companies have never been forbidden from covering people with pre-existing conditions, they just didn’t because it was too expensive for them. And technically, pre-Obamacare, someone with a pre-existing condition could’ve still gotten health care coverage, it was just exorbitantly expensive in most cases. So if things just went back to the way they were, the President could still technically say people with pre-existing conditions are covered, because he wouldn’t be doing anything to deny coverage to them. Whether they could afford it or not is their business.

So the President saying that he’s going to do something means very little when what he might do could mean so many different things.