The GOP is lying on pre-existing conditions that may have reached the peak of absurdity

President Donald Trump sent Wednesday another tweet on health care. "Republicans will totally protect people with preexisting conditions," he wrote. "Democrats will not do it!"

At present, the fundamental dishonesty of this statement should not require explanation.

Anyone, even vaguely aware of recent history – especially of the part where Democrats passed the Affordable Care Act, to ask Republicans to spend eight years trying to abrogate it – should recognize claim lie.

And anyone who does not know this saga could have just been paying attention this week, when the Trump administration announced a major reinterpretation of the Affordable Care Act insurance. rules. Change means that States can undermine some of the key provisions of the law that help people with serious medical problems.

This is just the latest example of Trump's attempts to get through regulations what Republicans have not yet managed to get through the legislation.

Wednesday, with the tweet and later a speech in WisconsinTrump claimed that none of this was happening. Just as he has before. As he is almost certain to do again on Thursday, when he will deliver a speech to the Department of Health and Social Services.

And it's not just Trump who gets into this kind of disappointment.

Republicans all over the country are promising voters that they are also committed to protect people with pre-existing conditions, although almost all have recordings to vote for efforts to cancel these protections (if they served in Congress) or to file lawsuits that would have the same purpose (if they hold a position at the state level). ).

All this should seem very familiar. Last year, when Republicans took power, they also insisted on their intention to protect people with pre-existing diseases. In realitytheir proposals would have removed the existing protections without providing a comparable replacement.

If the Republicans pass the mid-term elections with their respective majorities intact in Congress, next year could unfold in the same way. GOP Leaders have already done clear that they will once again try to repeal the law on health care if they can.

This is one of the reasons why duplicity of GOP is important. This is what party members will do in the future, not just what they have done in the past.

It is sometimes useful to remember what health care was like before the Affordable Care Act, and how many people with serious health problems were struggling to make up their minds if they had to buy insurance rather than their employer.

Insurers may charge higher premiums, refuse to pay bills associated with their pre-existing conditions, or simply deny coverage. The available policies often featured large gaps in benefits, such as limited prescription coverage or lack of payment for psychiatric services, largely because insurers knew that it was not a good practice. was a way to avoid paying big bills.

In short, a person with diabetes, HIV, bipolar illness or having survived cancer would have had a hard time getting insurance. And the only fonts available might not have paid their bills.

The Affordable Care Act has addressed this problem in two ways. First, it gave states money to expand Medicaid so that they could enroll all low-income people, including those with pre-existing conditions, directly into a government program. Then he restructured the private insurance market by banning all the old practices.

No need to charge existing people higher premiums or to refuse to cover expenses related to these conditions. No more denying their cover. More sales plans with giant profit spreads.

These changes have forced insurers to charge a lot more than before because they were now paying the medical expenses of people with serious medical problems. The architects of the law understood that this would happen and so they created a system of tax credits that can significantly reduce premiums, in some cases.

To ensure that people did not simply wait for illness before registering, the law provided for a financial penalty (the "Individual Warrant") for those who refused to take out insurance. It also set an open and fixed registration period that was very similar to that used by employers for their company policies.

In retrospect, the Affordable Care Act accomplished many of its goals. The number of people without insurance has reached unprecedented levels. A growing heap self-employed, peer-reviewed studies has shown that, overall, people are easier to get medical care, suffer less financial problems because of medical bills and are therefore healthier.

This does not mean that the law has worked well for everyone, or that some people do not feel much worse. Tax credits decrease as income rises, so people who earn more than four times the poverty line (about $ 100,000 a year for a family of four) get no credit .

They have to pay all the premiums, which in some parts of the country can be one-fifth of their income, before taking into account any costs. President Barack Obama is famous promised people who loved their old insurance keep it. They could not.

The anger that helped the Republicans win the election. Two years ago, it gave them complete control over the federal government and they had the right to work to repeal the health care act, as they had promised for a long time. But then it turned out that their plans would result in many millions of people lose health insurance and people with pre-existing conditions have fewer protections, even though Trump and his allies have repeatedly promised not to do so.

Republicans have been smart enough to conceal efforts. They ensured that the legislation included a broad, though ultimately meaningless, language about people with pre-existing conditions. They also included some of the key provisions of the law, including the prohibition of directly denying coverage to people with serious medical problems. But as experts have repeatedly pointed out, every proposal included loopholes insurers could and would like to exploit.

The policy change that HHS unveiled On Monday is a perfect example of how cunning works. On a technical level, the Trump administration has simply rewritten some regulatory guidelines that seem quite harmless. Seema Verma, the administrative head of federal health plans, did everything to say that the changes would not hurt people with pre-existing conditions.

But the orientation gives states leeway to rewrite the rules of their insurance markets by allowing the sale of policies that do not include pre-existing legislated protections – and then allowing people to use federal tax credits to buy them.

These plans will be financially attractive, although some buyers will not understand the limits or will become ill or hurt themselves after the purchase. In either case, they will end up with medical bills that they can not pay.

Meanwhile, insurers selling full policies will lose healthy customers, forcing them to increase their premiums. People who do not receive tax credits will find these policies even more expensive. And if the states decided at the same time to reduce the financial assistance granted to buyers of these plans – which the new decision could authorize, but experts are not sure – even those who qualify for tax credits could be in trouble.

The organizations that represent these people are one of the best judges of what change means for people with pre-existing conditions. Wednesday, 29 of them – including everyone froma American Cancer Society and the American Diabetes Association at the March of Dimes and the National Hemophilia Foundation – publishes a declaration warning that "this dangerous action could bring us back to the days when people with pre-existing conditions were openly discriminated against and categorically denied access to life-saving care.

Even these groups would admit that many people who buy a blanket are desperate for cheaper alternatives. The question is how to help them.

Democrats want to continue to push for universal coverage – whether by making the Affordable Care Act more generous, by urging the government to lower prices, or by creating public insurance programs that could supplement or even replace private insurance. These measures inevitably involve a combination of new taxes, public spending and regulations – and they inevitably call for redistribution, from healthy to sick and from rich to poor.

It's easy to see why these strategies would not please the Conservatives. But Republicans do not really have alternatives.

They will throw ideas into editorials – and sometimes more serious political writers on the right will think differently diagrams this, in a hypothetical political universe, could be close to providing the type of protection that the Affordable Care Act. But these ideas ultimately require similar combinations of expenses, taxes and regulations, and in real life, Republicans are simply not interested in this.

Instead, they resort to policy choices that would allow healthy people to benefit from a simple and inexpensive coverage, but only by making the full coverage more expensive for those who need it or want it.

It seems to be not what voters want to hear, which is why Republicans are trying so Wrong direction now – by misleading the public on the impact proposals that they have approved before or simply by offering stories of family members with medical conditions, in the hope of convincing voters that the professions considered by the Republicans are sincere.

The charade may have reached the peak of absurdity during the past week and a half, when two of the GOP leaders most famous for their hostility toward "Obamacare," Florida Governor Rick Scott, and Texas Senator Ted Cruz were among those who pledged to help people. with pre-existing conditions. Scott, now in the Senate, first went into politics fighting the Affordable Care Act. Cruz, who is busy defending his seat, once led a federal government shutdown in order to fund the program.

Trump is perhaps the most brazen of all. In addition to promulgating regulations that would undermine the provisions of the Affordable Care Act, he ordered his Justice Department to support a lawsuit that would declare the law unconstitutional.

This is a very unusual step because the Department of Justice usually defends federal laws in the courts, and even conservative legal experts find the case confusing. And yet, Trump is support that, which means that his administration literally asks a judge to reject the provisions of the law that Trump insists on wanting to respect.

Politicians deceive voters all the time, of course. But, for Republicans, distorting their approach to such a critical issue – pretending they are trying to help people get health care when they have spent more than eight years promoting policies that would remove it – is something else.

This could be a sign of despair By a party that knows that health care is an issue that could deprive them of their power bases in Washington and many capitals. But this could also reflect the confidence that, like Trump, elected in 2016 despite his obvious dishonesty in health care, may also win in the polls in November, and then get back to work a few weeks later. same protections that they continue to promise to preserve.