The Wall Street Journal offered an excellent editorial on May 1, “Pre-existing confusion” on the whole “Trump Care” bill that just passed a little while ago in the House, apparently by 217-213, along partisan lines. And the biggest point is still whether to go back to separating out higher risk consumers, so that most consumers don’t have to pay higher premiums to purchase care they will not use. It seems more acceptable to many of us to pay for unusual illnesses acquired mostly by misfortune publicly, through normal taxation and perhaps reinsurance.
The WSJ points out that guaranteed issue continues, and that states can only waiver out of community rating by doing something instead, like setting up high-risk pools. Yes, we’ve had them before and “liberals” say they weren’t enough. But there should be a mix of federal and state premium supports for sicker people who can’t afford them. In fact, for someone with inherited Type 1 Diabetes, unless he or she is rich and really can pay for the self (which the GOP understandably wants), he or she will need the premium support.
Critics are properly skeptical of “trusting” the states, given the history of the South.
I would add that reinsurance of excessive claims ought to be part of health care reform. Even people without pre-existing conditions could have catastrophic injuries, maybe caused by someone else’s negligence, resulting in very high claims. As Donald Trump has himself been am major employer (as are his two sons now), he ought to know this and want to include it.
And as Spicer insisted in meetings yesterday, premiums don’t rise for people who keep continuous coverage.
There can be some issues, like how to pay for HIV protease inhibitor therapy (which is usually effective but lifelong), or PrEP.
As for Medicaid reform, I remember working in New York State MMIS for Bradford National back in 1977-1978 when I was living in NYC well.