Monday, September 24, 2018
Opinion

Column: Latest GOP health plan would be devastating to Floridians

The U.S. House voted Thursday to repeal the Affordable Care Act and pass the Republicans' very own Trumpcare. Every Florida Republican except one voted in favor of the bill. Yet this bill is even worse than the previous version of the House health care plan, and it will jeopardize coverage for 7.8 million Floridians with pre-existing conditions.

Nationwide, an estimated 24 million would lose coverage under Trumpcare. Allocating this number by state, about 1.8 million Floridians would lose coverage — including 51,000 seniors who rely on Medicaid to pay for nursing homes and other services and 351,000 who currently have employer coverage.

Even if Floridians maintain coverage, it would be costly — especially for older enrollees. That's because the bill would allow insurance companies to charge them five times more than younger enrollees. Although older enrollees would get slightly higher tax credits, the credits would not nearly compensate for this cost increase.

The nonpartisan Kaiser Family Foundation ran the numbers. For a 60-year-old with an income of $40,000, premiums would go up by $7,390 in Collier County and by $4,280 in Miami-Dade County.

The bill passed Thursday would make these horrific outcomes even worse. One amendment would allow states to opt out of "community rating" — which under the ACA prohibits insurance companies from charging higher premiums to enrollees with pre-existing conditions.

Florida was one of the many states that allowed insurance companies to charge higher premiums for pre-existing conditions before the ACA, so it's likely the state would opt out.

President Donald Trump has pointed to a clause that supposedly guarantees coverage for pre-existing conditions. But if insurance companies can charge whatever they want, this promise is meaningless. That's why the American Medical Association wrote that the bill "could effectively make coverage completely unaffordable to people with pre-existing conditions."

Using data on how much more people with pre-existing conditions cost relative to healthy people, we can estimate how much more insurance companies would charge them in premiums. In Florida, insurance companies would mark up premiums for breast cancer by $27,000; for pregnancy by $16,000; and for diabetes by $5,000.

Republicans argue, without a CBO score or other evidence, that people priced out of the market would get coverage in "high-risk pools." But we know from experience that such pools wouldn't work in Florida.

Before the ACA, Florida's high-risk pool charged premiums up to 250 percent of average premiums. Unlike ACA coverage, the pool didn't cap out-of-pocket costs, limited coverage over a lifetime to only $500,000, and excluded coverage of pre-existing conditions for an entire year. Florida's pool was so severely underfunded that it froze enrollment in 1991 for two decades.

Some basic math shows that a new high-risk pool in Florida would also be severely underfunded. The House bill provides $138 billion in funding over 10 years; if allocated to states based on enrollment, Florida would get about $3.1 billion per year.

Assume that only 5 percent of Florida's enrollees have pre-existing conditions that would price them out of the market — a conservative figure given that 27 percent of Americans have serious pre-existing conditions. This would translate to 220,000 Floridians who would be quarantined into the high-risk pool from the individual and small group markets.

Now assume that the high-risk pool provides the same quality of coverage as ACA exchange coverage and subsidizes premiums by the same percentage. The average subsidy, multiplied by 220,000 people, would cost $4.7 billion per year — a whopping $2.58 billion more than the House bill provides.

Trumpcare, in short, would be devastating to Floridians. Almost 2 million would lose coverage, funding for care for seniors would be slashed, costs would spike for older enrollees, and millions with pre-existing conditions would have no security. In the Senate, our elected leaders must do better. Republicans can work with Democrats and improve the Affordable Care Act, but they must reject the bill passed by the House.

Topher Spiro is the vice president for health policy at the Center for American Progress, where he is also a senior fellow.

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