As voters worry about health care, Trump administration relaxes Obamacare rules

As voters worry about health care, Trump administration relaxes Obamacare rules


JUDY WOODRUFF: Now to the latest battle over
Obamacare, or the federal health care law formally known as the Affordable Care Act. The Trump administration announced yesterday
that it will allow states to go ahead with the sale of cheaper and skimpier health insurance
plans. But some of these do not have to cover preexisting
conditions, something that had previously been a legal requirement of Obamacare. And, as William Brangham tells us, that could
play right into a major election fight over that issue. WILLIAM BRANGHAM: Yesterday, the Trump administration
gave states new flexibility with their health care plans, allowing them to use federal subsidies
for cheaper plans that come with fewer required benefits. For example, they can now subsidize plans
that don’t have to cover prescription drugs or mental health or maternity care, all things
that the Affordable Care Act required. And these plans could also deny coverage to
people with preexisting conditions, as long as consumers still had access to another,
more comprehensive plan that guarantees that coverage. These sound like small changes, but they’re
not. And they will take effect starting in 2020. President Trump and many Republicans contend
these new options are exactly what some consumers want. But this comes as support for parts of Obamacare
are growing. And at least one recent poll found a majority
of voters say health care is very important in making their decisions come November. Margot Sanger-Katz covers all this for The
New York Times. And she joins me now. Welcome back. MARGOT SANGER-KATZ, The New York Times: Thank
you for having me. WILLIAM BRANGHAM: So, help us understand what
the Trump administration announced yesterday. What are these changes and what do they mean? MARGOT SANGER-KATZ: So, this is something
that was always in Obamacare. There’s a provision that allows states to
apply to do a totally different system if they want, but they have to adhere to certain
guardrails to make sure that they’re not taking coverage away from people who would have otherwise
gotten it. And the Trump administration put out new rules
for that process, where they basically said, we are going to be much more open-minded about
letting states throw out all the Obamacare rules and come up with their own way of managing
their insurance marketplaces. So this could include allowing plans that
cover fewer benefits, maybe don’t cover prescription drugs or mental health care. They are also including plans that maybe are
not available to people with preexisting conditions, or not available to them at the same price
as for other customers, and all kinds of other changes. Maybe the — who get the subsidy for what
could change. So we don’t know what the states are going
to do. But states are now welcome to bring these
proposals forward. And the Trump administration has said that
they are open to approving them. WILLIAM BRANGHAM: And is the concern that,
if federal subsidies now could be seen as another encouragement to people to buy these
plans, that people might be getting a plan that they think covers them, but then when
a crisis hits, they don’t really have coverage? MARGOT SANGER-KATZ: Yes, I think there are
two concerns. And they’re both important. So one is just that, that people may buy a
plan, and they’re healthy when they buy it, and they don’t really understand the fine
print, and they think it’s a good plan, and then, boom, their kid gets an illness or they
develop cancer or a drug addiction and suddenly when they realize that they need those benefits,
that they’re not there. So there is that concern, that these plans
that cover fewer things, that have more exclusions could have holes for individual consumers. And then I think there’s a broader concern,
which is that kind of cheaper plan that covers less, that might be good for someone who is
healthy and never has any health conditions and was never going to use their health insurance
anyway. But for someone who has a preexisting illness,
they are never going to buy that plan. It’s not going to be available for them. It’s not going to cover the benefits that
they need. And so what it does is it sets up these two
side-by-side markets, where all of the people with preexisting conditions buy the sort of
comprehensive Obamacare plans, and a lot of healthier people are willing to roll the dice
on these cheaper plans. And what can happen is that, because the way
insurance works is we’re sort of all pooling our premiums together to cover our collective
health bills, if you have one pool over here, where all the sick people are, and another
one over here with all the healthy people, that the price for buying insurance for sick
people could get really, really high. And that could make it unaffordable for a
lot of people who really need insurance the most. WILLIAM BRANGHAM: As we have seen, there are
people all over the country who are struggling to pay their bills. My colleagues were out in Idaho recently,
and they met a young woman who is — basically can’t afford health care. And she’s desperate. She sounds like she’d be an ideal customer
for a cheaper, maybe skimpier plan. Listen to what she had to say. SEMELE FREEMAN-HALL, Hairstylist: I absolutely
would try again for health insurance. And, actually, every year when the enrollment
comes up, I try, hoping for a miracle that there’s going to be a plan I can afford. I have never given up. I try every year. And then, every year, it hasn’t worked out. So, absolutely, I would — I would look at
it again. And if there’s plans out as early as next
week, I will look into it next week. WILLIAM BRANGHAM: I mean, this is a real issue
for a lot of people. MARGOT SANGER-KATZ: It really is. And I talk to these people all the time. It is true that Obamacare made health insurance
a lot more affordable for low- and middle-income people. It made it more accessible for people with
prior illnesses. But for a lot of people who make what we would
consider to be middle-class incomes, who don’t qualify for a subsidy, these insurance plans
can be really expensive, and they can be unaffordable. And we know that those people have been dropping
out of the market, and they’re going without anything. And so I think that policy-makers in the Trump
administration are trying to be sensitive to this population and say, OK, maybe these
skimpier plans aren’t quite as good, don’t have all the same consumer protections and
benefits as an Obamacare plan. But if people are choosing between this and
nothing, isn’t it better to give them something skimpier, and let them decide what’s the right
plan for them? Consumer advocates, I think, on the other
hand are very concerned about people sort of falling through the cracks and again about
the segmentation of the market. But I think that this person in Idaho is really
speaking to a real problem that we see in the country, because health insurance is just
so expensive. It’s quite out of reach for a lot of people. WILLIAM BRANGHAM: On a separate, but related
issue, the issue of preexisting conditions has become nationally a very big political
issue in the lead-up to the midterms. I want to show you two excerpts of some ads
that are running in Missouri, Senator Claire McCaskill and her opponent, A.G. Josh Hawley. Take a look at these. SEN. CLAIRE MCCASKILL (D), Missouri: Two years
ago, I beat breast cancer. Like thousands of other women in Missouri,
I don’t talk about it much, but those who face cancer and many other illnesses have
a preexisting condition when it comes to health coverage. Unfortunately, Josh Hawley filed a lawsuit
letting insurance companies deny coverage for those with preexisting conditions. That’s just wrong. JOSH HAWLEY (R), Missouri Senatorial Candidate:
Earlier this year, we learned our oldest has a rare chronic disease, preexisting condition. We know what that’s like. I’m Josh Hawley. I support forcing insurance companies to cover
all preexisting conditions. And Claire McCaskill knows it. WILLIAM BRANGHAM: How did preexisting conditions
become such a big issue in the midterm elections? MARGOT SANGER-KATZ: I think the real answer
is Obamacare repeal. So, as you may recall, over the last few political
cycles, Republicans have really run on this message that they want to repeal and replace
Obamacare. WILLIAM BRANGHAM: Which would get rid of coverage
for preexisting conditions. MARGOT SANGER-KATZ: It would. That was a really important part of Obamacare. It’s not the only way that you could take
care of these people. But it’s the way that we do it now in our
law. And when Republicans got really serious about
repealing the Affordable Care Act last year, I think that suddenly this law that had been
very controversial and had been pretty unpopular, people started to suddenly look at it differently. And we saw in the public opinion polls for
the first time that more people supported the Affordable Care Act than wanted it repealed. And that is a shift that has persisted. We saw a lot of engagement by kind of Democratic
activists, by disease advocacy groups, people who are lobbying on the Hill, organizing at
home. And it has become this really central issue
for Democrats, to say, we pass the Affordable Care Act, we’re suddenly proud of it, and
we are going to protect people with preexisting conditions. If you look around the country, this is the
number one issue for Democrats. There are more ads on health care than any
other subject. Polling has consistently shown that health
care is, if not the most important issue, the second most important issue to voters,
both in battleground states and all around the country. And I think Republicans now are kind of floundering
a little bit to find what their answer is going to be to this problem. And we see a lot of ads now and statements
from Republican candidates, like Josh Hawley’s ad, where Republican candidates, even those
who have voted for the Obamacare repeal proposal on the Hill or who, like Josh Hawley, are
part of a lawsuit that would seek to repeal the Affordable Care Act through the courts,
that they are saying, no, no, I’m still committed to preexisting conditions. I think it’s a little bit hard to believe
what they’re saying, even though I think there are possible ways that they could achieve
that, because they have not been very specific about how they would do it. And we have them on the record as being opposed
to the way that Democrats have achieved it. WILLIAM BRANGHAM: All right, Margot Sanger-Katz,
as always, thank you very much. MARGOT SANGER-KATZ: Thanks again.

Daniel Yohans

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