Soon after he took office in 2017, President Donald Trump famously bemoaned the difficulty of replacing the Affordable Care Act, which he had pledged to repeal on the campaign trail, with “something special,” as he put it.
"Now, I have to tell you, it's an unbelievably complex subject," Trump told a gathering of the nation’s governors. "Nobody knew health care could be so complicated."
Actually, a lot of people knew. Pretty much everyone who had seriously considered the subject — and who understood that providing health benefits that most people want is expensive — knew. It’s the reason why President Barack Obama and the congressional Democrats who adopted his signature legislation in 2010 paired affordable coverage for people with pre-existing conditions and a system of government subsidies, along with a mandate to push younger, healthier people to purchase insurance. They knew that this immensely popular provision had to be paid for somehow.
Large majorities of Louisiana residents support Medicaid expansion and state protections for people with pre-existing medical conditions if th…
Belatedly, a bunch of Louisiana politicians are now having their own “nobody knew” moment.
Two similar but competing bills to guarantee pre-existing condition coverage and other much-loved ACA benefits got their first airings last week, one in a state House Committee and one before a state Senate panel. Both ran aground over the simple, arguably obvious fact that somebody needs to pay. In the unlikely but not-out-of-the-question event that a current challenge to the health care law, popularly known as Obamacare, is upheld by the U.S. Supreme Court, it would be up to states to reinstate popular provisions such as this pre-existing condition guarantee.
The problem, some people were apparently surprised to find out, is that without the rest of the ACA, there’s currently no way to make it work financially. If the law goes away, it turns out, so do the subsidies that would pay for more expensive coverage. And that means that Louisianians would foot the bill unless the federal government decides to bail the states out. The Louisiana Department of Insurance says that under the proposals, costs would grow by between $634 million and $834 million by 2024.
Faced with that information, both bills were changed to only go into effect if federal money materializes. Neither got a committee vote, although they could come up again during the legislative session, and several lawmakers made it clear that they weren’t about to back what amounts to an empty promise.
"It's a farce. It's feel-good legislation to tell folks, 'We're going to take care of you if there's a pot of gold at the end of the rainbow,'" state Sen. Dan Claitor, R-Baton Rouge, said. "I think it gives people false hope."
Claitor was talking about a bill by state Sen. Fred Mills, R-Parks. It’s backed by Republican Attorney General Jeff Landry, a vocal ACA critic who has long argued that nobody should worry, that the states will step in and make everything OK. As the state’s lawyer, Landry has signed Louisiana on to the ACA challenge, which originated in Texas and has been approved by a federal judge there, and is backed by the Trump administration (the suit hinges on last year’s Republican-passed tax bill, which eliminates financial penalties for those who don’t carry insurance). The next stop is the Fifth Circuit Court of Appeals in New Orleans, and whatever that court decides, the matter is likely to wind up before the high court.
A second bill by state Rep. Chad Brown, D-Plaquemine, has support from Democratic Gov. John Bel Edwards, who backs keeping the ACA but wants to make sure the state steps in if it disappears.
Louisiana lawmakers on Wednesday began hearings on competing bills by two powerful political rivals that would enshrine in state law some of t…
Landry didn’t consult Edwards before entering the lawsuit, and the governor has pointed out that about 850,000 Louisianians have pre-existing conditions and could be endangered. That’s a huge number, and far fewer are currently on individual plans and benefiting from the provision. Still, anyone with a previous illness or condition who loses employer coverage and has to buy an individual plan could be affected in the future.
It’s a terrible position for anyone to be in, and Edwards is entirely correct that, should the law be overturned, Landry should be held responsible.
That likely would be little comfort, though, to Louisianians who have every reason to expect their elected representatives to understand the implications of what they’re doing before they act — no matter how often those politicians prove them wrong.