Mike Pence just settled it: Republicans’ Obamacare repeal bill can’t guarantee protections for preexisting conditions

The following article by Amber Phillips was posted on the Washington Post website September 21, 2017:

This post has been updated to include that Pence also said this: “But this legislation, Graham-Cassidy, as its authors have said, contains all the same protections for preexisting conditions as the President indicated.”

A major public flash point in Republicans’ efforts to repeal Obamacare is whether it will protect people with preexisting conditions.

We’re arguing about it for two reasons:

1. Jimmy Kimmel
2. What the bill says it would do on paper for people with preexisting conditions and what it would do in practice for people with preexisting conditions are very different.

Technically, this bill says health insurers can’t refuse sick people insurance like they could pre-Obamacare. If states ask the federal government to let insurers stop charging sick and healthy people the same amount, they have to explain how they’ll provide affordable coverage to sick people. But the bill doesn’t require states to follow through on it. It says if states request a waiver, the government has to grant it.

That would allow insurers to jack up the prices on sick people, something health-care analysts say insurers almost certainly will do given the chance, since covering sick people isn’t cheap.

The Post’s Laurie McGinley explains some of the surprising conditions that are considered pre-existing under Obamacare. (Victoria Walker, Dani Player/The Washington Post)

“It’s a de facto denial [to sick people],” said Gary Claxton, a health-care policy expert with the nonpartisan Kaiser Family Foundation. “You can charge them anything you want. Someone who’s actually in a spell of illness or who has a serious condition would get charged an exorbitant rate.”

Sen. Bill Cassidy (R-La.), author of the bill, focused on the regulation that, technically, insurers must provide people with preexisting conditions coverage. “More people will have coverage and we protect those with preexisting conditions,” he said Wednesday on CNN.

But if you ask that question a slightly different way to the bill’s supporters — can you guarantee people with preexisting conditions will get coverage — you get a totally different answer.

On Thursday, “Fox & Friends” co-host Ainsley Earhardt extracted such an admission when she asked Vice President Pence whether the bill can guarantee that sick people will be covered. Pence did everything but.

EARHARDT: “Can you guarantee that these governors will make sure preexisting conditions are covered?”

PENCE: “Thomas Jefferson said government that governs least governs best. I mean, the question people ought to ask is: Who do you think will be more responsive to the health-care needs in your community? Your governor and your state legislature or a congressman and a president in a far-off nation’s capital? I mean, this is the concept of federalism upon which our Constitution was framed. But this legislation, Graham-Cassidy, as its authors have said, contains all the same protections for preexisting conditions as the president indicated.”

Politician spin, translated: No I can’t. But we can have faith in the states that they’ll do the right thing for people.

Update: Pence said in that interview that this bill “contains all the same protections for preexisting conditions as the President indicated.” Which, as we explain above, is not how nonpartisan health-care analysts interpret the bill. 

Even if you agree with that governing philosophy, health-care analysts caution that this bill isn’t setting states up for success. The bill provides far less funding to most states compared with Obamacare. What federal funding states do get could disappear completely after 2026 if Congress doesn’t reauthorize the program.

That means states would have just a few years to come up with a health-care program from scratch, and no guarantee that the federal government would help out after that.