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Obama knocks GOP’s stance on preexisting conditions during pandemic

Endorsing his former vice president, Joe Biden, to win the White House, former President Barack Obama sought to contrast the 2020 platforms of Democrats and Republicans on a critical plank: their stance on the Affordable Care Act. It’s a difference, he argued, that has assumed newfound urgency.

“The Republicans occupying the White House and running the Senate … have shown themselves willing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis,” Obama said.

Obama was referring to a couple of GOP policies, the former president’s senior adviser Eric Schultz told KHN. The first: a pending Supreme Court case, Texas v. Azar, in which the Trump administration has argued the 2010 health law should be struck down. Schultz also highlighted the White House’s refusal to provide a special open enrollment period for the ACA health exchanges in the midst of the coronavirus pandemic.

We’ve previously checked claims about President Donald Trump’s stance on the law’s preexisting condition protections — arguably its most popular component ― and his position on the Texas v. Azar lawsuit.

But COVID-19 adds new relevance, because of both the virus’s devastating health implications and bludgeoning impact on the American economy. Indeed, the Trump administration’s handling of the virus crisis is shaping up to be a defining issue in the run-up to November. Meanwhile, Biden made the health care law a signature component of his presidential platform and has been a vocal critic of the administration’s pandemic response.

With that in mind, we decided to take another look.

The Republican agenda

Obama is correct: The Republican Party has opposed the ACA for years. In 2016, then-candidate Trump campaigned on its repeal. Since then, the White House and congressional Republicans have pursued an agenda that would dismantle the law’s preexisting condition protections. Republicans haven’t united behind an alternative plan, either.

第一:诉讼。德州诉Azar案源自2017年《减税与就业法案》。这项措施不符合健康法的个人要求,要求所有美国人都必须拥有健康保险或支付罚款。由共和党人推动并由特朗普签署的税法将该罚金设为0美元。

现在,一批共和党州检察长认为,如果没有罚款,其余的卫生法将行不通,应予以废除。

取消ACA可以消除以下规定:如果保险计划已存在,则该计划不能向人们支付更多费用;支出它为有人提供的在交易所购买保险的补偿,并取消可在六年内直接 扩大覆盖范围的医疗补助计划 超过1300万人。最高法院已同意审理此案,但要等到十一月大选之后才能裁决。

实际上,政府  甚至支持  各州应予以废除。白宫和参议员的建筑物,但拒绝支持这一法律-法律专家称此举几乎是史无前例的。共和党人都没有提出替代法案,以在高等法院裁定违法的情况下维持ACA的保护。

我们问白宫,政府在大流行之后是否改变了立场。临时的工作人员将我们重定向到联邦政府法律部门司法部。该部门未回复通过电子邮件提出的放置评请求。不过,就在三 月底,公认告诉记者,他仍然希望该法律“终止”。

民主党人参议院 已推动  政府改变对诉讼的立场。但是,参议院占据多数席位的共和党人保持 沉默,自从COVID-19关闭有效值了该国的大部分地区以来,这一立场就没有改变。

公共政策智囊团 美国企业研究所American Enterprise Institute)的常驻代表托马斯·米勒(Thomas Miller)认为,在某些方面,共和党的立场并不重要他说,很难想象最高法院将废除卫生法,特别是在COVID-19中。

结果,这并没有改变先前所引发的事实。

诉讼只是等式的一部分。另一个是Healthcare.gov。

Americans who have lost their jobs ― and, often, the insurance that came with it — are eligible to buy insurance on the federal exchange, since job loss is a “qualifying life event” that gets you special access. Those who otherwise lack coverage would normally have to wait until the regular open enrollment period, which takes place at the end of the year. But the threat of COVID-19 has changed the risk for many of these potential shoppers.

In response, 11 states have independently reopened their state-run health exchanges for a special sign-up period. But the administration has declined to take such steps for the national marketplace.

“If you have been uninsured and picked up your newspaper, or turned on your news and realized your health was in much greater risk than you had anticipated, and would like to rush and get health insurance in case you end up on a ventilator ― you’re out of luck,” said Linda Blumberg, a health policy fellow at the Urban Institute, a nonprofit research organization.

Even before coronavirus, the institute estimated that 32 million Americans were uninsured. About 20 million of them could benefit from a special enrollment period, Blumberg said. Without insurance, coronavirus treatment poses not just a health risk, but also a financial one.

The Trump administration has said it will pay hospitals directly, out of a pool of $100 billion, to cover the cost of treating uninsured people with COVD-19. After treating patients, hospitals would get paid at the Medicare rate.

But the administration’s policy extends only to covering COVID-19 treatment. Uninsured people with underlying chronic conditions don’t have a way to pay for health care, noted Robert Berenson, another Urban Institute fellow. If left untreated, those chronic ailments make COVID-19 far more dangerous than it would be for someone able to get preventive treatment earlier on.

Coronavirus and the ACA

President Trump’s stance raises another question, experts noted. Without the ACA, what kind of impact would COVID-19 have?

Even with the heath law intact, many Americans won’t be able to find affordable health insurance. That particularly applies to people who can’t afford the premiums on the individual marketplace, don’t qualify for federal subsidies or live in one of the 14 states that didn’t opt into the ACA’s Medicaid expansion provision.

And the ACA is nowhere near sufficient on its own, Miller noted. Having insurance is part of the picture, but it doesn’t guarantee access to testing or that a hospital will be able to treat you. “On the margins, it does help a little bit to have insurance coverage, but the problem is so much larger than that,” Miller argued.

Still, without the health law, the virus’s impact would be “catastrophic,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill.

凯撒家庭基金会副总裁拉里·莱维特(Larry Levitt)说,打击单个市场和扩大医疗补助将使大约2,000万人没有保险-“不仅有患COVID-19的疾病,而且还有大量医疗费用的风险。” (KHN是基金会的独立编辑程序。)

如果没有ACA,则COVID-19可能被视为已存在的疾病。保险公司可以向以前感染该病毒的人收取更高的费用(当然,假设这些人可以进行检测并记录为患有COVID-19)。此外,新兴的证据表明,严重的COVID-19病例可能会留下持久的健康后果,即使恢复后仍需要持续的医疗服务,莱维特说。

奥伯兰德说:“ ACA的消费者保护措施确保拥有COVID-19的人可以获得保险,而不必担心因其原有状况而被拒之门外或被收取过高的保费。”

卫生法还对保险必须涵盖的范围进行了严格的规定。布伦伯格说,如果没有这些规定,计划可能会(而且很可能会)恢复到更 轻率的 范围。

她说,这意味着计划可能不包括呼吸机或品牌药品,或者限制他们将覆盖多少天的医院护理,或者要求人们支付更多的自付费用。

她说:“考虑到这样做的法律能力,保险公司将限制其法律责任并保护自己免受高额索赔的伤害。” “他们以前做过,并将再次做过。”

我们的裁决

奥巴马指责特朗普政府和参议院共和党人“即使在这次公共卫生危机中,也愿意削减数百万人的健康保险,并取消数百万人的既有条件保护”。

 

证据表明这是适当的表征。如果最高法院对ACA作出裁定,则没有人提出可以维持覆盖范围或保护消费者的计划。这项政策使数百万的美国人受益。正如奥巴马所断言的那样,在没有同等替代者的情况下废除法律可能是毁灭性的,尤其是在COVID-19大流行期间。

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