Obamacare repeal is back: New Trump plan guts pre-existing conditions, basic benefits

Donald Trump and conservatives in the US House have reportedly come up with a new compromise to gut the Affordable Care Act, aka Obamacare.

Under the new Trump/Ryan plan, states would be able to opt-out of the ACA’s pre-existing condition protections and basic benefits requirements.

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1) Add your name to those demanding Congress not repeal the ACA or any of its benefits.
2). Then, follow up with an email to your members of Congress.

Pre-existing conditions protections to be removed

Under the ACA, insurance companies are no longer permitted to refuse you coverage, or charge you more for coverage, because of a pre-existing health condition. In the past, something as slight as asthma or gastritis was enough for insurance companies to refuse to sell you a plan, or to charge you an exorbitant price for lousy coverage. Under Obamacare, insurance companies must charge you the same rate they charge everyone in your geographic area and age group.

Under the new Trump/Ryan plan, states can opt-out of the pre-existing conditions requirement, and instead set up “high-risk” pools — basically, insurance ghettos. People with pre-existing conditions, from allergies to cancer, would be forced to buy insurance on a separate market where they could be charged practically anything, and there’d be no guarantee that the coverage would be any good. Many states had high-risk polls pre-Obamacare, and they routinely failed because they weren’t sufficiently funded, there were long waiting lists to even get into the pools, and people couldn’t afford the high premiums.

Basic benefits guarantee to be removed

Under the ACA, every insurance plan has to offer you a basic package of 10 essential benefits, including prescription drugs, maternity, emergency care, mental health, lab services, and more. Under the new Trump/Ryan plan, states can opt-out of the essential benefits, permitting them to pare down plans, excluding all sorts of important benefits, the way they used to.

But that’s not all the ACA did

Before the ACA, many insurance plans had annual and lifetime limits. My plan, for example, only let me buy $1,200 worth of prescription drugs per year. And while that may sound like a lot, my one asthma drug, Advair, costs around $300 or more per month.

But that’s not all. Many plans had an annual or lifetime limit on all coverage. Meaning, if you have cancer for example, you only get so much treatment per year. And after several years, they’ll eventually cut off your insurance. This happened to film critic Roger Ebert, who wrote about how his insurance had cut him off, but he was lucky enough to have multiple insurance plans because of his previous jobs.

What does this mean for you?

Well, if you stay healthy the rest of your life, don’t develop allergies, eczema, high cholesterol, asthma, heart problems, joint issues, cancer or any other health condition — and don’t care about anyone among your family or friends who might get any of those conditions — then you might be fine under the Trump/Ryan plan.

If you ever get sick, however, in any way shape or form — or anyone you love ever gets sick — they’re in trouble.

The basic compact of insurance is that you buy insurance all your life, and for many years likely pay more into it than you get out, as a form of protection against coming down with something serious like cancer, or any surgery that might cost tends of thousands of dollars (appendicitis, for example, can cost $20,000 or more, and emergency room visits routinely cost sever thousand dollars for the most benign things). Insurance is a gamble — you pay into it, hoping that you’ll never need it.

Under Trump Ryan, you’re expected to pay more into insurance than you need when you’re healthy, then when you’re finally not healthy, they dump you and charge you even more.

But I thought the ACA only applied to poor people and people who work for themselves – nope.

One thing that I’ve found confusing in the Obamacare repeal coverage is the issue of who exactly benefits from Obamacare. Much of the reporting makes it sound like the ACA only applies to people in the “marketplace,” who tend to be people who work for themselves or are unemployed or in school. In fact, many of the ACA’s protections apply to everyone.

For example, the pre-existing conditions protection protects everyone, even those at a regular job. In the past, if you had a pre-existing condition and started a new job, you might have to wait a year before your new insurance would cover that condition. Now that’s no longer the case. Also, employers didn’t have to cover all the basic benefits, now they do.

But there’s another way the Trump/Ryan bill can affect people who don’t work for themselves, or otherwise currently have insurance. What if your status changes? Meaning, what if you lose your job? When I left the UN, I wasn’t allowed to get COBRA coverage, I had to go and buy my own insurance. Without the ACA, I likely would have been turned down because of too many pre-existing conditions.

Or what if you get your insurance through your spouse’s work, and you get a divorce or your spouse dies? Then what happens? Then, you may have to go get your own insurance, and the Obamacare protections will help you massively.

One final scenario. What if you move to another state? Insurance is state-based in the US. Meaning, if you currently have Blue Cross of Illinois and move to Washington, DC, you have to end your coverage with the Illinois company and buy new insurance with the entirely separate Blue Cross company in DC. And before Obamacare, the new company in the new state could deny you, or charge you a lot more, based on your pre-existing conditions. Effectively, you can never move to another state unless you have a job with a company, and even then, pre-ACA they might not cover your existing health problems for a year.

We must save the Affordable Care Act. We know what the world was like before the ACA, and while Obamacare has its problems, it’s a lot better than the dog-eat-dog insurance market we had before.

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19 Responses to “Obamacare repeal is back: New Trump plan guts pre-existing conditions, basic benefits”

  1. Richard Patterson says:

    Part D also has a little known ban on federal government drug price negotiation. In other words, unlike every other country int he world, the US government is the only one not allowed to negotiate drug prices with their manufacturers… which allows drug companies to charge whatever the hell they want, wherever the hell they want, with absolute impunity, answerable to no one but their profit-motivated shareholders. Other bans on this outside of medicare also exist, which prevents those without elderly and disabled prescription needs from benefiting from a negotiated drug price, as well. The Republicans recognise the price gouging problem, but still defend it on the principal of patent protection and their laissez faire ideals. The Democrats recognise the problem and actually have an idea of what to do, but are the minority and can’t get a damn thing done. However long this Long Night might last, the damages will just keep mounting. It is possible we may never see a sufficiently liberal country again and alot of old, disabled, poor, and medically needy will die. The Republicans will say how sad it is, but do nothing to fix it, because they still believe that your state of health and how you receive care is purely your responsibility and if you’re too poor, then they silently agree with Social Darwinism.

  2. run75441 says:


    Not to interfere with this discussion, you do know the ACA Risk Corridor and the Reissuance programs were self funding as scored by the CBO. Then Sessions Upton, and Kingston cut the funding to them. And we both know there was no way the Repubs would allow Obama and the Dems determine alternate funding for these two programs.

    Both of these programs (which also exist in Part D) were in place to reimburse insurance companies for having patients with severe illnesses and pre-existing conditions. Then too, any objections by an insurance company was appealable in the ACA.

    Sorry to interfere, I was reading yours and the others dialogue.

  3. Rick_B says:

    I live in a state representative district which used to be represented by the long-time Texas Dean of liberal Democrats, and was reorganized to be largely Hispanic. My new state representative has a Hispanic name and a reputation for voting with the Republicans. It is rumored that he hates living in this district with all the poor Mexicans.

    My new federal Congressional representative is decent, but as a replacement for Martin Frost he isn’t of a lot of value in the Congress. Because he is Black all the minorities were packed into his district and the surrounding Congress-turkeys are all Republican.

    Texas politicians Paxton and Abbot are gutter-slime passing for Christians.

  4. Houndentenor says:

    I live in Texas too and I am very concerned about what’s coming next all the time.

  5. Houndentenor says:

    Yes, but what about everyone else. Will enough people care to keep the pressure up. Republicans have a long history of being persistent and getting away with doing unpopular shit. We can’t just assume that people are going to care. I live in a state where 1 in 4 people didn’t have health insurance before the ACA. No one here gave a flying fuck about that and most still don’t. This is going to be a long uphill battle until we can get these shitbags out of office and that is at least 18 months away.

  6. Rick_B says:

    And then some of us live in Texas, run by GOP evangelicals who are in their private hours much worse than Ted Cruz.

  7. Rick_B says:

    People who are sick with chronic conditions or likely to get ill and don’t have adequate insurance are not going to forget!

  8. Rick_B says:

    If high risk pools offer normal rates and coverage with the shortfall
    made up by tax money, the overall cost to government is exactly the same
    as the current ACA, or more.

    Yep. Except our fragmented and disorganized health care system delivers less efficient health care at much higher prices than in other countries. But we DO create more healthcare delivering millionaires than any other wealthy nation in the world.

    Actually the Law of Large Numbers allows statisticians to predict very accurately how many people will get what illnesses and what they will cost as long as the risk pool is representative of the population. But insurance companies get wealthy by cutting out individuals and small groups from the overall risk pool, offering them lower cost insurance, then writing policies that exclude the most expensive care.

    Look at the GOP healthcare proposals. They entirely consist of excluding the most expensive care. That permits insurance executives to get wealthy because they leave people to die without care. None of the elements of the GOP healthcare revisions involve improving healthcare delivery. They ALL are based on not paying for health care for the most expensive illnesses!

  9. Rick_B says:

    America pays at least 30% more for health care services (I have seen statistics that show we pay nearly twice as much), and yet gets ranked in the bottom of the Industrial Nations for health care results. What is the GOP solution? Stop paying for the care of the most expensive patients. Let them die. Hey, they’re not rich people anyway, are they? And only brown people or the elderly get severely sick, right?

    Not improving health care delivery – just stop paying for it if people get sick. That’s the 24 million or so losing health care. I guess if you get cancer you are supposed to go out and earn more money to pay for Chemotherapy or something.

  10. Keith Elmore says:

    Why do they continue to do this? It is politically harmful and leads to a negative news cycle. I might write about this on my blog: https://civilitycommons.wordpress.com/

  11. Lenarbeach says:


  12. Houndentenor says:

    They are counting on us having a short attention span. Based on our country’s history that is not a bad bed, but I don’t think it’s going to work this time.

  13. Houndentenor says:

    My Congressman is a doctor and a teabagger. There’s a town hall Saturday morning. I already called his office before the last vote. This time I’ll voice my opinion in person. This vote hurts thousands in our district. maybe we can finally vote this fucktard out of office.

  14. Quilla says:

    Let me guess. Being President is hard. Being in Congress is hard. Actual governance is beyond the scope of most of these elected turds…so…keep picking that health care scab again and again and again because, seriously, who needs to do anything else for the same amount of money, perks, and air time?

  15. MoonDragon says:

    I’m sure there are delusional people who KNOW their state wouldn’t screw them, but if another state wants to do so, tough luck to the people of that state. I’m waiting for those people to have a Beatrix Kiddoe epiphany.

  16. Demosthenes says:

    You have Trump figured out to a “T”!

  17. emjayay says:

    If high risk pools offer normal rates and coverage with the shortfall made up by tax money, the overall cost to government is exactly the same as the current ACA. It’s just moving money around. The only way to save money overall without screwing people is systemic change on the health care provider and fee side.

    But for Republicans high risk pools are a big savings, allowing tax cuts for the rich and corporations, because the premiums and copays would be much higher (and you know how sick people can make lots of money to pay their bills) and the plans way underfunded from the government side, plus of course good old annual and lifetime limits etc.

  18. Considering how angry people were the last time they tried this, it’s amazing they’re trying again. This is Trump’s hubris. He wants a win, he doesn’t care about the substance.

  19. Demosthenes says:

    My U.S. Rep. is a Democrat and so are both of my congressmen. They all will oppose the latest Trump GOP scheme to fund tax cuts for the rich by stripping tens of millions of health insurance.

    The GOP never learns.
