Who's right — President Trump and Sen. Bill Cassidy, or late-night host Jimmy Kimmel?
None has really captured the complexity of the debate over who might lose insurance protections in the latest Republican health care bill. But of the three, the TV guy is the hardest to refute.
Trump insists in a tweet that the bill covers pre-existing conditions, a point also made by Cassidy, a sponsor of the legislation. But there's a catch. It allows states to get a waiver from "Obamacare" requirements that insurers charge the same to people with health problems as they do to healthy people. The potential result: unaffordable premiums for people in poor health.
Here's a look at Trump's assertion, the facts and the Kimmel-Cassidy feud:
Trump: "I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace."
The facts: Such coverage may be included but it's far from assured.
The health care law enacted by President Barack Obama in 2010 offers two levels of protection for people with pre-existing conditions. The GOP bill would allow states to undermine one of them. That loophole could lead to policies priced out of reach.
To start with, Obamacare requires insurers to take all customers, regardless of health problems. On top of that, it prohibits insurers from charging more on account of medical conditions.
Under the GOP bill moving toward a Senate vote next week, insurers would still be required to accept people with pre-existing conditions. But here's where the catch comes in:
States could seek waivers that allow insurers to charge people more on account of health problems. That would allow insurers to offer lower-premium plans to healthier customers.
And states could also get waivers that allow insurers to tailor benefits so that people with costly conditions are discouraged from signing up. For example: plans that don't cover treatment for substance abuse problems.
"If I was a person with a pre-existing condition, I would say I don't have any guarantee of getting health insurance if the bill passes," said Gary Claxton of the nonpartisan Kaiser Family Foundation, an expert on the private health insurance system.
"Insurers can charge people with pre-existing conditions much higher rates, making it essentially a denial," added Claxton.
Dr. Michael Munger of Kansas City, Kansas, estimates that 4 in 10 of the patients in his family medicine practice have some sort of condition that could result in higher premiums.
"Individuals that I care for have had a previous cancer diagnosis, underlying diabetes complications, previous heart attacks and heart surgeries," he said. "I am very worried about affordable coverage. We have had a lot of gains and this is certainly something I don't want us to go backward on."
Munger is president of the American Academy of Family Physicians, which is among the major doctors' groups opposing the GOP legislation.
Supporters of the bill, named for its chief sponsors Sens. Lindsey Graham of South Carolina and Louisiana's Cassidy, point out that the legislative text says states seeking federal waivers must explain how they will "maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions."
But Claxton says there's nothing in the text to define what "adequate and affordable" means and, as he reads it, it's unclear if the federal government would even have authority to deny a state waiver application. The bill also reduces federal money, adding to the pressures on states.
The health insurance industry is on record saying the bill would create problems by "pulling back on protections for pre-existing conditions," according to a letter to lawmakers from the trade group America's Health Insurance Plans.
Cassidy is in a public battle with TV host Kimmel about whether the bill meets the "Jimmy Kimmel test." That's a phrase coined by the senator this year after Kimmel gave a heartfelt account of how his infant son got surgery to correct a birth defect, and declared that all American families should have access to high-level care.
Kimmel says the senator should stop using his name. "This new bill actually does pass the Jimmy Kimmel test, but a different Jimmy Kimmel test," said Kimmel. "Your child with a pre-existing condition will get the care he needs if, and only if, his father is Jimmy Kimmel."
Cassidy says Kimmel doesn't understand the legislation.
Kimmel's critique goes to the core of the issue. But it's more nuanced than either he or Cassidy acknowledge, says insurance industry consultant and blogger Robert Laszewski. He points out that governors and legislatures would have to take action to weaken insurance protections guaranteed in federal law under Obama. Those state lawmakers would face pushback from consumers and medical groups, so it's not a given that such protections would be lost.
Nonetheless, Laszewski says Republicans have created a problem for their legislation.
"I think they made a huge mistake by leaving a crack open," said Laszewski. "And Jimmy Kimmel and the Democrats are going to try to drive a truck through it."
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