How Fox News dealt with CBO saying 23 million would lose coverage under the AHCA

Vox

How Fox News dealt with CBO saying 23 million would lose coverage under the AHCA

We watched every instance in which Fox News had to confront the number.

Updated by Alvin Chang May 31, 2017

The morning after a nonpartisan analysts reported that the Republican replacement for Obamacare would cause 23 million people to lose their health insurance — many of them in the reddest states — Fox & Friends invited President Trump’s budget director, Mick Mulvaney, onto the show.

The exchange went like this:

BRIAN KILMEADE (host): 23 million will lose insurance. True or false?

MULVANEY: False. If you look at the methodology, they assume that folks who were on Medicaid, which is free, will choose to get off Medicaid when the mandate goes away. Now you tell me if this sounds like the real world.

STEVE DOOCY (host): Sure. And I know the [Congressional Budget Office] looked at it. Millions of Americans are not going to buy insurance if they don’t have to because they don’t want to.

It was one of the rare instances Fox & Friends mentioned the “23 million” number, but a quintessential example of how the Fox News Channel has often covered the devastating CBO analysis — by obscuring details and blaming the source, which is similar to how right-wing news sites cover this administration.

Mulvaney does both, saying CBO erred in saying people would voluntarily leave Medicaid. He (and the hosts) fails to mention that the bill kicks low-income adults without children off Medicaid and makes it easier for states to kick people off the program.

It’s part of a pattern on Fox News, which often framed the CBO score in two ways. The first was that the CBO analysis is wrong, or that CBO has been unreliable in the past. The second is that Obamacare is failing and this bill gives people the freedom to escape that failure.

Not thinking too hard about the human cost

As my colleague Jeff Stein writes, this bill is a bigger liability for Republicans than Trump’s scandals. It’s what Democrats are campaigning on and what seems to have the most resonance, perhaps because people don’t want to be in the traumatic situation of having to choose between financial ruin and medical treatment.

Many of those who stand to lose insurance live in states that voted heavily for Trump. The bill hurts a host of demographic groups that support Trump — including older Americans, those who live in more rural areas, and areas suffering most from the opioid crisis.

The CBO scores get at the heart of these fears.

So the injection of these numbers into the AHCA debate caused a dissonance on several Fox News shows. When Fox & Friends had to confront these numbers, the reaction was to minimize the CBO analysis. For example, in March, after the first CBO report, Kilmeade acknowledged that Trump voters would be hurt but assured them this was part of a larger plan:

They say the people that are going to be hurt most under the current plan, the way the calculus is done by the CBO, are Americans between the age of 50 and 64. Right before Medicare, the older part and last leg of their career. That translates into mostly Trump voters.

But then you factor in the fact that this is a three-phase plan. The second phase is when [Health and Human Services Secretary] Tom Price is supposed to theoretically sit there and put in regulations that’ll make this more of a conservative project.

Host Ainsley Earhardt questioned the CBO, saying:

Here’s the thing. Donald Trump says the Democrats are the ones that put us in this mess. They are complaining about this.

Can you really trust the CBO? Can you trust the report?

Jonathan Gruber, the architect of Obamacare, he said blatantly — we played the sound bites for you yesterday — he said we can trick the CBO, call them mandates and not taxes, and they will pass this thing through.

Then on May 4, the House prepared to vote on the second version of the AHCA without a CBO score showing the policy’s impact. That morning, Doocy confronted the “24 million” number by saying it’s better because it “reduces taxes and stuff like that”:

When you saw that figure a month or two ago, where something like 24 million would wind up losing their health care: That is a great political ad for the Democrats, whoever is going to run against any of the Republicans coming up in 2018.

But here’s the thing: What if it’s — the hope for everybody is this is actually better. Reduces taxes and stuff like that.

And ultimately, when it comes to politics, this is going to redeem Speaker Paul Ryan. Plus, it’s going to give President Trump his first big — and it is big — legislative win.

I’m largely focusing on Fox & Friends because it has one very important viewer — President Trump — who has praised the show multiple times, and even thanked them for helping him win the presidency. It is the inner monologue of a president who has aggressively criticized most other media outlets for their reporting of his presidency.

Some shows on the network were slightly more nuanced, saying that people will choose to be uninsured because Obamacare will no longer mandate people to have insurance.

The bottom third also suggests the new version of the bill protects people with preexisting conditions. It does not.

There was little talk of why the mandate existed in the first place, and the mechanism the AHCA uses in its place: a penalty for people who want to buy insurance on the marketplace after a lapse in coverage.

Painting the CBO — and subsequently the media — as biased

Occasionally a guest would be on a Fox News show to represent the opposing viewpoint, and they would defend the 24 million number, though almost immediately a conservative guest or the host would reframe the discussion around CBO’s credibility or Obamacare’s failure. But it was this inherent conflict — between left and right, between “them” and “us” — that framed the coverage around the CBO report.

After watching the nearly 100 times people on Fox News confronted these numbers, the CBO report stopped feeling like a number describing humans. Rather, it felt like a political concoction — a number whipped up to make Obamacare repeal harder.

In fact, media outlets and experts who cited the CBO score were also treated with contempt. Below is a screenshot of a segment on how unfairly the mainstream media is treating the AHCA after the CBO score:

It’s cruel to disorient people like this

American health care is complicated. This AHCA debate is complicated. Yet it’s these complicated details that determine the cost and quality of care for our bodies.

So when nonpartisan analysts say that a bill will cause 23 million to lose insurance in 10 years and make costs skyrocket for older and poorer Americans, it should clarify our political opinions.

But Fox News has taken advantage of television as a medium to try to convince its viewers that “23 million” is a partisan tool, not an evidence-based projection. It’s basing its rhetoric on personality, on partisanship, on tribalism, and insisting that people trust them, not the mainstream media or the nonpartisan analysts who are desperate to take down Donald Trump.

Let’s put it this way: When our satellites tell us a powerful hurricane is headed toward us, it’s irresponsible not to tell everyone to get out of the way. But convincing the people that the tools are malfunctioning, that the hurricane isn’t coming their way, that the rest of the news reports are wrong? That’s cruel.

Two Scientists, Two Different Approaches To Saving Bees From Poison Dust

NPR

Two Scientists, Two Different Approaches To Saving Bees From Poison Dust

Dan Charles May 27, 2017

A tractor pulls a planter while distributing corn seed on a field in Malden, Ill. Two scientists agree that pesticide-laden dust from planting equipment kills bees. But they’re proposing different solutions, because they disagree about whether the pesticides are useful to farmers.

Bloomberg/Bloomberg via Getty Images

It’s planting time in America. Farmers are spending long days on their tractors, pulling massive planters across millions of acres of farmland, dropping corn and soybean seeds into the ground.

Most of those seeds have been coated with pesticides known as neonicotinoids, or neonics for short. And despite attempts by pesticide makers to reduce this, some of that coating is getting rubbed off the seeds and blown into the air. That dust is settling on the ground, on ponds, and on vegetation nearby.

Honeybees and wild bees, looking for food, will encounter traces of the pesticides, and some will be harmed. They may become disoriented and bring less food back to their colony. Many may die.

Several years ago, Christian Krupke, an insect specialist at Purdue University in Indiana, became one of the first researchers to discover that rogue dust was wiping out bee colonies. At first, Art Schaafsma, an entomologist at the University of Guelph, in Canada, didn’t believe it was true.

“Unfortunately — myself included — in the early days there was a lot of skepticism,” Schaafsma says. He regrets that reaction now. “We do have a problem, and we’ve got to fix it,” he tells me.

There are a lot of things that Krupke and Schaafsma disagree about when it comes to neonicotinoids. Krupke believes — while Schaafsma does not — that bees may also be harmed by exposure to smaller quantities of neonicotinoids that show up in the leaves and pollen of plants grown from coated seeds, or even in wildflowers that grow in or near fields where the crops are planted.

They do agree that the dust is a problem. They just have different ideas about how to fix it.

Schaafsma’s solution is sitting in a garage on the Ridgetown Campus of the University of Guelph. It’s a shiny new piece of farm equipment, a seed planter that Schaafsma has taken apart and re-engineered.

Like most modern planters, it uses air pressure to move the seeds from a storage bin through tubes and into the soil. Schaafsma points to the end of one pipe. “This is the air intake, OK? See the problem already?

That pipe is close to the ground. When a tractor pulls this planter across a field, dust will get sucked into this opening, along with air. Inside the planting mechanism, “the air is rushing past that seed, it’s laden with dirt, and it’s acting like a sandblaster,” Schaafsma says. That dirt grinds a little bit of the neonicotinoid coating from the seed, and then carries the pesticide dust with it as it exhausts from the planter, straight up into the air.

That’s normally how the planter works. But Schaafsma has made some changes on this one, outfitting it with special dust traps, similar to high-quality vacuum cleaner filters. “We’re probably filtering 99 percent of what comes out of the exhaust,” he says.

Schaafsma thinks that this equipment, if installed on all seed planters, would eliminate most of the risk to bees from neonicotinoid-treated seeds.

Schaafsma has been testing his theory by setting up honeybee hives near corn fields that were planted using his filter-outfitted equipment, monitoring these hives and measuring their honey production. “We just want to demonstrate that it can be done — that bees and corn can co-exist,” he says.

Schaafsma wants co-existence because he wants farmers to be able to use neonicotinoid-treated seed. “I see them as valuable tools, which should be handled with care,” he says.

This, however, is where Schaafsma and Christian Krupke part ways. Krupke is not convinced that farmers are getting much benefit — if any — from the seed coatings. In most cases, Krupke says, the pesticides don’t appear to be worth the money that farmers are spending.

So his solution is even simpler: Stop using them so much. At the very least, he says, seed companies should give farmers the option of planting seeds without neonicotinoids on them. Right now, it’s often difficult to find such untreated seeds.

This month, Krupke and some colleagues published two scientific papers with evidence to support his case. The first study, conducted by researchers at seven Midwestern universities, concluded that neonicotinoid-treated soybean seeds performed no better than untreated seeds in fending off aphids, one of the major pests that the seed treatments are supposed to control. According to the study, farmers would be better off leaving their seeds untreated, monitoring their fields, and resorting to conventional spraying of pesticides when the aphids attacked.

In another study, Krupke found that the seed treatments weren’t of much benefit to corn yields, either. In some fields, pesticide-treated seed performed better, in other fields it did worse. Combining the results from all the sites, the average yield from the treated seed was about 2 percent higher, but Krupke says that difference is not statistically or economically significant — certainly not the kind of clear effect that would justify its use on nearly all the corn in the country.

Companies that sell seeds and neonicotinoid pesticides have attacked similar studies in the past, arguing that farmers clearly do see benefits from the seed treatments, because they’re happy to pay for them. Other researchers, including Schaafsma, have reported that treated seed has produced higher yields, with the increase ranging from 1.5 to 5 percent.

Krupke says he’d like to do more extensive studies comparing treated and untreated seed, but companies that control the seed now are refusing to provide samples for him to use.

Krupke says that there’s growing interest among farmers in plant seeds that are not treated with neonicotinoids — if only they could find such seeds.

Schaafsma, for his part, thinks it will be easier to stop dust pollution from seed planters than to convince farmers not to use pesticide-coated seeds. This is something that farmers clearly would like to do, he says, and it’s technically feasible. Bayer CropScience, the big chemical company that sells most of the neonic seed coatings, has developed its own version of a dust trap that could be installed on planters.

The problem is, none of the big farm-equipment companies are offering the dust traps for sale. These companies that make planting equipment, such as Case, Kinze, and John Deere, have installed shields that direct the neonic-laden exhaust down toward the ground, rather than into the air, but Schaafsma says that’s not good enough.

“The only people who don’t recognize [the problem] well enough yet are the equipment manufacturers,” he says.

The place in America where (almost) no one drinks their tap water

Christian Science Monitor

The place in America where (almost) no one drinks their tap water

Local officials in eastern Kentucky’s Martin County insist the water is fine, despite repeated violations of EPA limits. But residents have been relying on bottled water for years.

Story Hinckly Staff writer

May 18, 2017 Inez and Tomahawk, Ky.—T.J. Fannin, sitting on his porch as the sun sets, speaks fondly of the 27 years he spent working in nearby coal mines. But despite the hard labor that fueled a coal boom and sent millions of dollars into Kentucky’s coffers, he says he and his neighbors lack a basic amenity: clean tap water.

“[O]n the TV you see someone go to the faucet and get a drink of water, and it just makes me mad cause, you know, we can’t do that,” says Mr. Fannin, who buys two or three 24-packs of bottled water a month for drinking and cooking. “There’s an odor to the water…. It’s just like stagnant water [that] comes out of the bottom of a pool.”

It’s no secret that the decline of coal has hit the mountain spine of Appalachia hard. But it’s less well known that an amenity of life most Americans take for granted isn’t a given, more than 50 years after Lyndon B. Johnson launched his “war on poverty” here in Martin County, Ky.

And what really gets Fannin’s goat, he says, is that residents here face far higher water bills than in nearby counties. This, despite frequent warnings that the local water has exceeded Environmental Protection Agency (EPA) limits for certain chemicals.

“We should have a top-notch water system, septic system, schools, roads,” given all the proceeds from coal mining over the years, says the former miner. “We got this 4-lane [highway] down here and that’s basically all we got.”

In a place where political distrust runs high and funds are scarce, little has been done to improve the county’s water quality or infrastructure, as reported by the Ohio Valley Resource’s Benny Becker in January.

Local officials argue that the water issue has been blown out of proportion by a handful of outspoken residents, whose activism sends the water district jumping through bureaucratic hoops instead of fixing a creaking system. For the rest of the community, relying solely on bottled water is seen as just a way of life, not a reason to protest.

Two students hanging out in the high school parking lot say their parents have always had a family rule against drinking from the tap. Becky, a grocery cashier in nearby Warfield, says she hasn’t consumed the county’s water since 1999. Neither a hardware-store owner nor a retired butcher can remember the last time they drank from the tap.

“There is a fundamental breakdown in the expectation of democracy in places like Appalachia,” says Alexander Gibson, director of Appalshop, a media organization in Whitesburg, Ky. “They have observed that a complaint to the government disappears like the morning fog.”

Exceeded EPA limits repeatedly since 2005

In the bowels of the Martin County Water District offices, Joe Hammond sits in front of an Excel sheet, a map of the county’s water lines taped on the wall above him.

Piles of paper teeter beside his elbows, while packs of bottled water are stacked next to the filing cabinets. He says the girls in the office drink that, not him. As far as he’s concerned, the local water is fine.

“I raised two fine young children with that water,” says Mr. Hammond, the supervisor of the water district.

But Lee Mueller, who was also born here, became concerned about the water when he moved back in the 1980s.

“I had written stories about it for years,” says Mr. Mueller, who served as the Lexington-Herald Leader’s eastern Kentucky bureau chief for three decades. He blames the water quality for his own cancer diagnosis. “I didn’t really get involved with water until we were getting notices of violation that were two months old from the water district that they were required by law to inform residents that they had exceeded contaminant levels for various cancer-causing agents.”

According to Kentucky Division of Water records, Martin County’s water system has exceeded EPA limits for certain chemicals in its drinking water multiple times every year since 2005. Martin County was out of compliance in eight of the last 10 tests for haloacetic acid (HAA5) limits and 6 of the last 10 tests for total trihalomethanes (TTHM) limits.

These chemicals – by-products of chlorine treatment intended to make the water palatable – aren’t considered as dangerous as the lead that laced Flint’s water in Michigan. But the notifications sent to residents by the water district warn that extended exposure increases the risk of cancer.

Gail Brion, an engineering professor at the University of Kentucky who previously worked for the EPA, says the agency sets conservative limits for HAA5s and TTHMs. But an ethical controversy arises, says Professor Brion, when the government gives you no choice but to pay for bottled water in order to avoid this health risk.

Funding and priorities

The highest elected official in Martin County, Judge Executive Kelly Callaham, can be found in his corner office in the county’s newest courthouse. When asked about his county’s water quality, Judge Callaham leans forward in his chair and waves one hand in the air.

“You could drink four gallons of our water every day for 70 years and you have a chance of getting cancer. Well, hell, if you eat hot dogs, read what’s in hot dogs. You could eat four hot dogs a day for 70 years and you probably wouldn’t last 70 years,” says Callaham. “ ‘Could cause cancer,’ and ‘will cause cancer’ is a whole different deal.”

Callaham blames the EPA-mandated notices and the local newspaper, the Mountain Citizen, for what he considers unnecessary hysteria.

Editor Gary Ball has published a steady stream of articles on the water issue, as well as Callaham’s alleged misuse of county finances, including the $10 million courthouse building. “The system has been mismanaged for years,” Mr. Ball says.

Kentucky began issuing a “severance” tax on coal companies in 1972 to assist economic development. According to state records obtained by the Monitor, out of $34.5 million in coal severance funds disbursed since 2001, Martin County spent $7.3 million – or about 21 percent – on sewer and water improvements.

Comparatively, state Senator Ray Jones – who represents five counties including Martin County – says his home of Pike County spent 70 to 75 percent of its severance tax funds on water and sewer infrastructure.

“A lot of it comes down to funding,” says Senator Jones, “but a lot of it comes down to priorities.”

Among other projects, Martin County spent about $3.3 million in coal severance funds on the new courthouse, and another $7 million to build the Inez Business Center. Local critics say these funds could have made a big dent in repairing Martin County’s water system, with estimates of total renovation running between $13 and $15 million.

Coal severance revenues have plummeted in recent years. In 2016, Martin County received only 12 percent of what it got in 2009. Today the revenues provide just enough to cover the bond payments on the new courthouse.

Callaham says he wouldn’t have built it if he knew the coal severance money was going to run out so quickly.

But Darren Sammons with the Kentucky Department of Local Government says, “[W]e have been advising local officials for years to expect lower coal severance revenues and to budget accordingly.”

A system built for 600, serving 3,500

Meanwhile, Hammond is left to address the water district’s manifold problems as best he can.

Martin County’s water system – including a treatment plant – was built in 1968 for 600 customers. It currently serves 3,500. This expansion of lines in eastern Kentucky’s rocky hills created an underground system susceptible to holes and line breaks – and therefore water loss.

The EPA estimates the average water loss in the US to be 15 percent per month, but Martin County has been under investigation by the Kentucky Public Service Commission (PSC) in recent years for water loss rates greater than 60 percent.

When there’s a problem, Martin County residents often call the local newspaper instead of the water district, circumventing Hammond.

The newspaper goes directly to the PSC, which responds to the paper’s complaints by issuing Hammond extensive paperwork, which he says diverts resources away from dealing with customers’ problems.

“I’m still working on things they have asked for” – back in June 2016, he says.

‘People are afraid to complain’

A Facebook group called Martin County Water Warriors, which has more than 1,000 members, regularly posts updates on water quality issues – everything from photos of corroded water heaters to updates about the next hearing on Martin County’s water (June 1 in Frankfort, Ky.).

Nina and Mickey McCoy, longtime environmental activists, say they have also tried to organize citizen meetings to demand action on the city’s water quality, but with little effect. Once, they ordered dozens of pizzas and not a single person showed up.

In a place where Big Coal holds so much sway, few are willing to publicly share their grievances.

“People are afraid to complain about the water,” says Mr. McCoy, because they fear losing their jobs or severance packages. “Or their third cousin might be fired. It runs deep.”

There’s also a pervasive feeling that speaking up won’t accomplish anything.

“The government just doesn’t seem to work on this level for the people,” says Dan Preece, a world history teacher at Sheldon Clark High School – who is willing to speak on the record only because he is tenured.

“When the kids see over time what does get spent here … you see a new courthouse built, but we can’t get the water fixed,” says Mr. Preece. “They don’t feel like they matter, like this is not a problem worth solving.”

But Jones, for one, is working on solving it.

“It needs to be a collaborative effort between local officials, local citizens, and state officials,” says Jones, who in February introduced legislation to give the PSC greater leverage over water districts. “It’s not going to be resolved overnight… but there needs to be a plan.”

Staff writer Christa Case Bryant contributed reporting.

CSM, In Pictures Water: a vital resource in crisis

http://www.csmonitor.com/Photo-Galleries/In-Pictures/Water-a-vital-resource-in-crisis#710033

Trump administration rejects ban on harmful insecticide, dozens of farmworkers get sick

ThinkProgress

Trump administration rejects ban on harmful insecticide, dozens of farmworkers get sick

Chlorpyrifos is linked to neurotoxic symptoms like nausea, dizziness, and confusion.

By Esther Yu Hsi Lee, Immigration Reporter at ThinkProgress. May 15, 2017

More than 50 farmworkers in California became sick from pesticide drift, Kern Golden Empire reported, one month after a controversial pesticide was deemed safe to use by the Trump administration.

On May 5, workers harvesting cabbage on a farm near Bakersfield were exposed to a “pesticide odor” from mandarin orchards in the west sprayed with Vulcan, an organophosphate-based chemical. The active ingredient in Vulcan is chlorpyrifos, a chemical linked to human health problems manufactured by Dow AgroSciences, a division of Dow Chemical. Chlorpyrifos was slated to be banned by the U.S. Environmental Protection Agency under the Obama administration.

Approximately 12 people with symptoms of vomiting and nausea were decontaminated, but 11 of those 12 refused any further treatment, according to an incident log on the Kern County Fire Department webpage. One person was taken to the hospital while more than half of the farm-workers left before medical personnel arrived on scene. The Kern County Fire Department, Kern County Environmental Health and Hazmat responded to the area for a mass decontamination.

“I’m not pointing fingers or saying it was done incorrectly. It was just an unfortunate thing the way it was drifted,” Efron Zavalza, Supervisor and Food Safety Specialist at Dan Andrews Farms where the incident occurred, told the publication. “The wind came and pushed everything east and you know we were caught in the path.”

“Anybody that was exposed, that was here today, we encourage them to seek medical attention immediately. Don’t wait. Particularly if you’re suffering from any symptoms. Whether it’s nausea, vomiting, diarrhea, seek medical attention immediately,” Michelle Corson, Public Relations Officer, Kern County Public Health, said.

Chlorpyrifos — a widely-used organophosphate insecticide in use for over 50 years — is used on a variety of crops like oranges, apples, cherries, grapes, and broccoli. It can cause neurotoxic symptoms in humans like nausea, dizziness, and confusion. When exposed to high dosages, humans can suffer from respiratory paralysis or death. A study by researchers at Columbia University found that exposure was linked to brain function and lower IQ among children. For years, environmental groups have pressured the EPA to look into the correlation between pesticide usage and problems that could affect workers on an organic and cellular level.

Also at ThinkProgress: Dow Chemical gave $1 million to Trump’s inauguration, now wants pesticide risk study buried.

During the Obama administration, EPA scientists recommended taking chlorpyrifos off the market. Despite the scientific evidence, new EPA Administrator Scott Pruitt rejected the ban on chlorpyrifos on the grounds that the agency needs to “provide regulatory certainty” for the thousands of U.S. farms that rely on chlorpyrifos. Dow Chemical donated $ 1 million to fund Presdient Donald Trump’s inauguration ceremony. In a letter to the Trump administration sent in April, Dow Chemical asked the administration to “set aside” and ignore research showing that the pesticide could be harmful to endangered species.

U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare

LA Times

U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare

Michael Hiltzik, Contact Reporter May 12, 2017

Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.

Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $34-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued on Monday blocking the merger.

Aetna executives had moved heaven and earth to conceal their decision-making process from the court, in part by discussing the matter on the phone rather than in emails, and by shielding what did get put in writing with the cloak of attorney-client privilege, a practice Bates found came close to “malfeasance.”

Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger. — U.S. District Judge John D. Bates

The judge’s conclusions about Aetna’s real reasons for pulling out of Obamacare — as opposed to the rationalization the company made in public — are crucial for the debate over the fate of the Affordable Care Act. That’s because the company’s withdrawal has been exploited by Republicans to justify repealing the act. Just last week, House Speaker Paul Ryan (R-Wis.) cited Aetna’s action on the “Charlie Rose” show, saying that it proved how shaky the exchanges were.

Bates found that this rationalization was largely untrue. In fact, he noted, Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations. Bates’ analysis relies in part on a “smoking gun” letter to the Justice Department in which Chief Executive Mark Bertolini explicitly ties Aetna’s participation in Obamacare to the DOJ’s actions on the merger, which we reported in August. But it goes much further.

Among the locations where Aetna withdrew were 17 counties in three states where the Department of Justice asserted that the merger would produce unlawfully low levels of competition on the individual exchanges. By pulling out, Aetna could say that it wasn’t competing in those counties’ exchanges anyway, rendering the government’s point moot: “The evidence provides persuasive support for the conclusion that Aetna withdrew from the on-exchange markets in the 17 complaint counties to improve its litigation position,” Bates wrote. “The Court does not credit the minimal efforts of Aetna executives to claim otherwise.”

Indeed, he wrote, Aetna’s decision to pull out of the exchange business in Florida was “so far outside of normal business practice” that it perplexed the company’s top executive in Florida, who was not in the decision loop.

“I just can’t make sense out of the Florida decision],” the executive, Christopher Ciano, wrote to Jonathan Mayhew, the head of Aetna’s national exchange business. “Based on the latest run rate data . . . we are making money from the on-exchange business. Was Florida’s performance ever debated?” Mayhew told him to discuss the matter by phone, not email, “to avoid leaving a paper trail,” Bates found. As it happens, Bates found reason to believe that Aetna soon will be selling exchange plans in Florida again.

As for Aetna’s claimed rationale for withdrawing from all but four states, Bates accepted that the company could credibly call it a “business decision,” since the overall exchange business was losing money; he just didn’t buy that that was its sole reason. He observed that the failings in the marketplace existed before Aetna decided to withdraw, but that as late as July 19, the company was still planning to expand its footprint to as many as 20 states. In April, top executives had told investors that Aetna had a “solid cost structure” in Florida and Georgia, two states it dropped.

While the Department of Justice was conducting its investigation of the merger plans but before the DOJ lawsuit was filed, “Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger,” Bates observed. During a May 11 deposition of Bertolini, an Aetna lawyer said that if the company “was not ‘happy’ with the results of an upcoming meeting regarding the merger, ‘we’re just going to pull out of all the exchanges.’”

Not such a veiled threat? Aetna’s Mark Bertolini tells the DOJ what will happen if it blocks the Humana merger. After the DOJ sued to kill the deal, Aetna cut back even more.

In private talks with the DOJ, Aetna executives continually linked the two issues, even while they were telling Wall Street that the merger was “a separate conversation” from the exchange business. Bertolini seemed almost to take the DOJ’s hostility to the merger personally: “Our feeling was that we were doing good things for the administration and the administration is suing us,” he said in a deposition.

Bates found “persuasive evidence that when Aetna later withdrew from the 17 counties, it did not do so for business reasons, but instead to follow through on the threat that it made earlier.”

The threat certainly was effective in terms of its impact on the Affordable Care Act, since Aetna’s withdrawal has become part of the Republican brief against the law. That it says so much more about Aetna executives’ honesty and integrity probably won’t get cited much by GOP functionaries trying to repeal the law. Aetna is at least partially responsible for placing the health coverage of more than 20 million Americans in jeopardy; that it did so at least partially to promote a merger that would bring few benefits, if any, to its customers is an additional black mark.

If there’s a saving grace in this episode, it’s that the company’s goal to protect the merger hasn’t worked, so far. The DOJ brought suit, and Bates has now thrown a wrench into the plan. Aetna has said it’s considering an appeal, but the merger is plainly in trouble, as it should be.

Thoughts From a Hospital Bed

Esquire

Thoughts From a Hospital Bed

And what it means to be healthy, or unhealthy, in the United States of 2017.

By Charles P. Pierce May 3, 2017

I wasn’t awake for 30 minutes Wednesday morning before the panel on MSNBC’s Morning Zoo Crew made me wish that there was a procedure by which they could put my gallbladder back, just so they could take it out again. The subject was Hillary Rodham Clinton’s appearance at a woman’s conference on Tuesday. First, Harold Ford came on—and who’s more of an expert of losing winnable elections than Harold Ford, Jr.?—and said that, instead of talking about the election just passed, HRC should be out there talking about “what she would be doing as president.”

Just thinking about the reactions in many quarters, from this bunch, from The New York Times’ Washington Bureau, if she actually did this—She’s Delusional! She Thinks She’s President!—made me long to be back on Toradol again. (By the way, if you know anyone who wonders why NFL players do what they call “riding the T train” before every game, send that person to me. Toradol is very good at its job.) Then, Mika informed us that one of the major blunders of the Clinton campaign was that it didn’t realize that the arrival of Donald Trump “changed the moral calculus” of the race and would sideline Bill Clinton as a political asset. That got me longing to start the whole process again, perhaps with a rusty lawnmower blade.

I can’t leave you alone for a minute, America.

So anyway, this happened. Last Tuesday, I awoke in the middle of the night feeling as though I’d swallowed an ankylosaurus, spiked tail and all. (It was a good day for dinosaur news, because it’s always a good day for dinosaur news, but it wasn’t a good day for metaphorical dinosaur news.) That brought me to the emergency room. The next afternoon, I felt as though someone was pounding a railroad spike into my right side. After a series of tests that covered 14 hours and included an endoscopy, an ultrasound, an MRI, and a more elaborate MRI, it was determined that the ol’ gallbladder had run the race, that it had to come out, but that it had not made the argument for its removal in a conventional way. I had, as they said, “an atypical presentation of a common condition.”

New title for the memoirs!

So, anyway, this happened. Before relieving me of the offending organ, the surgeon and I were chatting, and he mentioned that, in college, he’d played defensive tackle at Trinity College in Connecticut, in which capacity he annually ran into a plucky offensive lineman named…Bill Belichick. So that was weird.

The staff at Newton-Wellesley Hospital, all of them, will always have my thanks and prayers. But although Jimmy Kimmel beat me to this by a couple of days, what continued to strike me over the past week was the fact that the critical element in my care was that I could afford it.

The critical element in my care was that I could afford it.

After a while, the Toradol and I conjured up a guy in Mississippi who worked in a plastics plant. (He also works at the local Piggly Wiggly to make ends meet.) Last Tuesday, he wakes up in the middle of the night with the anklyosaurus in his gullet. He probably downs an over-the-counter stomach medicine. The next day, at work, he feels the railroad spike’s being driven in. He has to make calculations in currencies with which I am not familiar and in which I am not fluent. Antibiotics exchanged for food, school fees bartered for an ultrasound. Or maybe he just soldiers through, day after day, until a chronic condition becomes catastrophic and the ankylosaurus breaks through into his life like the critter from Alien leaping from John Hurt’s chest. I really got to like this guy. I wished him well.

From this standpoint, with my Mississippi plastics worker hanging out at the side of my bed, I watched the Republicans fall all over themselves trying to destroy the Affordable Care Act while pretending they weren’t doing that very thing. (An atypical presentation of a common condition.) For a good, long, healthy while, I was completely one of The American People, my privileged view of our democratic follies clouded for a moment by more than just the pharmaceuticals. I was looking through a haze of frustration and pain, and considerable anger, for me and for my phantom pal from the plastics plant. Human health is not a commodity, to be bargained and sold and traded as though it were any other consumer good.

I was lying in a hospital, doped to the gills, chatting in my mind with an imaginary fellow citizen, and I could figure that out. Why in bloody hell can’t they? They’re out to wreck the only piece of effective legislation that made this a little easier for me and for my pal that has emerged in the last half-century. Everything about the proposed replacement is cruelly inadequate, because that’s what it was designed to be. The pre-existing conditions protections are cheesecloth; the high-risk pools are guaranteed to bring us back to the days of generally unaffordable premiums. It’s still a tax bill dressed up as healthcare reform, which is like calling a crop subsidy a law enforcement measure.

And hand things back to the states? To Sam Brownback’s Kansas, or Scott Walker’s Wisconsin, or even my phantom companion’s Mississippi? Somehow, doing this, bringing millions of Americans back to the brink of a cliff they’d almost forgotten over eight years, makes those Americans more free? This is crazy. I turned on the hockey game.

Human health is not a commodity, to be bargained and sold and traded as though it were any other consumer good.

The debate on the essential American political identity—which I contend began in all modern contexts with the belated acknowledgement of the rights granted to African-American citizens in the wake of the Civil War—has not even half-begun. The question of who we are as a nation is as unresolved as it ever has been. The value of the political commons—and the distribution of the benefits thereof—is still in a perilous place. The notion that the American republic is an ongoing experiment in self-government is one to which I still subscribe, but, dammit, these days, we seem to be closer than ever to the moment when that experiment turns to one of complete devolution, as we walk the republic back through all the mistakes of the past from which we’d thought we learned. Hell, the Greeks knew that social inequality was the route through which democracy turns to oligarchy. We were supposed to have learned that in 1787.

**Also, in case you haven’t noticed, the president* of the United States is bughouse bananas and he’s getting worse.**

So, anyway, all this happened. My family and I would like to thank you magnificent bastids, one and all, for the great outpouring of thoughts, prayers, good wishes, and raisings of the glass that came to us from all across the Intertoobz. There’s something stirring out in the land, I swear to god there is, and I’m glad we’re all here in this thing called life together.

So, anyway, that all happened. The shebeen is open again, praise be. God bless all here!

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A look at the House Republican health care bill

Associated Press May 4, 2017

WASHINGTON (AP) — House Republicans on Thursday passed legislation to roll back much of former President Barack Obama’s health care law. The legislation would rework subsidies for private insurance, limit federal spending on Medicaid for low-income people and cut taxes on upper-income individuals used to finance Obama’s overhaul.

The nonpartisan Congressional Budget Office estimates that the Republican bill would result in 24 million fewer people having health insurance by 2026, compared to Obama’s 2010 statute.

Here are key elements of the bill:

__Ends tax penalties Obama’s law imposes on individuals who don’t purchase health insurance and on larger employers who don’t offer coverage to workers.

__Halts extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid to do so. Changes Medicaid from an open-ended program that covers beneficiaries’ costs to one that gives states fixed amounts of money annually.

__Erases Obama’s subsidies for people buying individual policies based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums. The credits are refundable, which means they can go to people with little or no tax liability. Credits may not be used to buy policies that provide abortion coverage.

__Repeals Obama’s taxes on people with higher incomes and on insurance companies, prescription drugmakers, some medical devices, expensive employer-provided insurance plans and tanning salons. Obama’s law has used the revenue to help pay for expanded coverage.

__Requires insurers to apply 30 percent surcharges to customers who’ve let coverage lapse for more than 63 days in the past year. This would include people with pre-existing medical conditions.

__Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like. Obama’s law limits the difference to a 3-1 ratio.

__States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.

__States can get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases. Critics say these pools are often under-funded and ineffective.

___Provides $8 billion over five years to help states finance their high-risk pools. This late addition, aimed at winning over votes, is on top of $130 billion over a decade in the bill for states to help people afford coverage.

__Retains Obama’s requirement that family policies cover grown children to age 26, and its prohibition against varying premiums because of a customer’s gender.

___

Sources: U.S. Congress, The Associated Press, Kaiser Family Foundation

GOP Health Care Bill Would Cut About $765 Billion In Taxes Over 10 Years

NPR Politics

GOP Health Care Bill Would Cut About $765 Billion In Taxes Over 10 Years

Scott Horsley May 4, 2017

The Affordable Care Act took money from the rich to help pay for health insurance for the poor. The repeal bill passed by House Republicans would do the opposite. The health care bill passed by the House on Thursday is a win for the wealthy, in terms of taxes.

While the Affordable Care Act raised taxes on the rich to subsidize health insurance for the poor, the repeal-and-replace bill passed by House Republicans would redistribute hundreds of billions of dollars in the opposite direction. It would deliver a sizable tax cut to the rich, while reducing government subsidies for Medicaid recipients and those buying coverage on the individual market.

Tax hikes reversed

The Affordable Care Act, also known as Obamacare, is funded in part through higher taxes on the rich, including a 3.8 percent tax on investment income and a 0.9 percent payroll tax. Both of these taxes apply only to people earning more than $200,000 (or couples making more than $250,000). The GOP replacement bill would eliminate these taxes, although the latest version leaves the payroll tax in place through 2023.

The House bill would also repeal the tax penalty for those who fail to buy insurance as well as various taxes on insurance companies, drug companies and medical device makers. The GOP bill also delays the so-called “Cadillac tax” on high-end insurance policies from 2020 to 2025.

All told, the bill would cut taxes by about $765 billion over the next decade.

The lion’s share of the tax savings would go to the wealthy and very wealthy. According to the Tax Policy Center, the top 20 percent of earners would receive 64 percent of the savings and the top 1 percent of earners (those making more than $772,000 in 2022) would receive 40 percent of the savings.

Help for the poor reduced

Over time, the GOP bill would limit the federal contribution to Medicaid, while shifting control of the program to states. Depending on what happens to costs, states may be forced to provide skimpier coverage, reduce their Medicaid rolls, or both. The Congressional Budget Office estimated that an earlier version of the bill would leave about 14 million fewer people covered by Medicaid by 2026. (The House voted on the current bill without an updated CBO report.)

CBO also anticipated fewer people would buy insurance through the individual market. With no tax penalty for going without coverage, some people would voluntarily stop buying insurance. Others would find coverage prohibitively expensive, as a result of changing rules governing insurance pricing and subsidies.

The GOP bill would allow insurance companies to charge older customers up to five times more than younger customers — up from a maximum 3-to-1 ratio under the current health law. The maximum subsidy for older customers in the GOP plan, however, is only twice what is offered to the young.

The bill also allows insurance companies to offer more bare-bones policies. As a result, young, healthy people could find more affordable coverage options. But older, sicker people would likely have to pay more.

In addition, because the subsidies offered in the Republican plan don’t vary with local insurance prices the way subsidies do in Obamacare, residents of high-cost, rural areas would also suffer. That could include a large number of Trump voters.

A Vote To “Harm Millions of Americans:” Study Released Today Predicts Disaster With TrumpCare.

DailyKos

A Vote To “Harm Millions of Americans:” Study Released Today Predicts Disaster With TrumpCare.

By Dartagnan May 04, 2017

Republicans working hard to screw millions of Americans out of their health care

David Leonhardt of the New York Times draws our attention to a Harvard study being released today that reveals just how harmful a “health care” package the Republican House and Donald Trump are about to foist on the American public. It is one that will raise premiums and prompt millions to opt instead to go uninsured, further driving prices up for everyone.

The study is based on an analysis of Massachusetts’ subsidized exchange health insurance system system. Put simply, it shows that when even relatively modest premium cost increases are imposed on lower income individuals, they tend to choose to go uninsured, preferring to stick to “emergency room” treatment.

The Massachusetts method allocates subsidies to lower-income people by separating them into categories of income—a family making $ 44,701 per year, for example, can end up paying several hundred dollars more per year then someone making $44,699. It’s not a perfect or even wholly equitable system, but it has the virtue of being well-studied. The clear-cut thresholds of income-based premium costs that result from the Massachusetts system provide an opportunity to analyze people’s behavior in a more straightforward way, with fewer variables and more reliable results.

What the Harvard study clearly shows is even a slight price increase in premiums will make lower-income folks disinclined to sign up. And if that sounds obvious, it should. All this new study does is back it up with hard data:

Why? Partly because people know that they have an alternative. They can instead rely on last-minute emergency-room care, in which hospitals typically treat them even if they lack insurance. Such care is problematic: It tends to be expensive, raising costs for other patients, and it’s often not as good as preventive care. But many poorer families choose E.R. care over taking money from their stretched budgets for health insurance.

The Republican plan being voted on today will increase costs to low income individuals not just a little, but significantly. Most affected will be lower-income, older Americans because of the way the system is designed—tax credits based primarily on age, not geographic area or ability to pay. That is a major distinction between the Republican plan and The Affordable Care Act (“Obamacare”), and its impact will be staggering, because for low-income, aged individuals only the very sick (and desperate) will be willing to pay those premiums. According to the three authors of the Harvard study—one of whom, Amy Finkelstein of MIT, is regularly touted by such conservative outlets as the Wall Street Journal– the rest will largely opt out of the entire system:

“When premiums go up, it’s the healthier enrollees who drop out,” said Amy Finkelstein of M.I.T., another author of the study.

The implications of the Harvard study on what the Republicans are voting on today are even more ominous than the already damning analysis of the Congressional Budget Office, which predicted that the Republican plan will kick 24 million people off of their health insurance:

[T]he magnitude of the new results suggests the C.B.O. estimates of insurance losses were conservative. Nathaniel Hendren of Harvard, the paper’s third author, said that the Republican proposal would effectively end enrollment in the insurance markets for families that make less than $75,000 a year.

So this is what the Republicans are voting to do to the American public today. Their prime—indeed their only– motivation for this is to cut the same taxes on multimillionaires that permitted Obamacare’s success in providing millions of Americans with good health care coverage . As Leonhardt notes:

The Republican health bill is simply a bad bill. It’s been blasted by conservative and liberal health experts, as well as groups representing patients, doctors, nurses and hospitals. Above all, the bill cuts health benefits for the poor, the middle class, the elderly and the sick, and it funnels the savings to tax cuts for the rich.

The Republican health care bill is a recipe for disastrous, out-of control premium hikes for millions. Unfortunately for all of us, the GOP Party leadership has secured just enough “yes” votes to make its passage probable today, while sparing so-called “moderate” members of their caucus the political consequences and allowing them to vote “no.”

But those “moderate” Republicans own this as much as their colleagues, because this act of violence against Americans in taking away a system (“Obamacare”) already proven to work has been the longstanding, explicit policy of their Party leaders, whom they eagerly voted into that position. And the pain it causes will affect all Americans, including ones who live in so-called “moderate” Republican Districts:

The bill could cause more people to lose insurance than previously predicted and do more damage to insurance markets. The $8 billion sweetener that Republicans added to the bill on Wednesday would do nothing to change this reality. President Trump and Speaker Paul Ryan are continuing to push a policy that would harm millions of Americans.

Americans must remember that in 2018, when it will be time to pay back the GOP for what it did today.

House Republicans are hell-bent on ripping away our health insurance. Call your member of Congress at 202-224-3121, and demand they vote NO on a renewed Trumpcare that is worse than the one before. Remind them they work for you.

If you have trouble getting through or their “mailbox is full,” you can work through AARP (which vehemently opposes this Bill) to connect you to a live person to answer: AARP’s #: 844-259-9352.

After announcing her retirement, one GOP congresswomen is torching the GOP health care plan.

DailyKos

After announcing her retirement, one GOP congresswomen is torching the GOP health care plan.

By Jen Hayden May 04, 2017

U.S. Rep. Ileana Ros-Lehtinen (FL-27) recently made a surprise announcement that she will be retiring, not seeking re-election in 2018. Perhaps that has freed her up to speak the truth about the impending disaster of a massive tax cut for the wealthy, stealthily disguised as a health care plan , because today she issued a statement saying she intends to vote against the Trumpcare AHCA bill. Rep. Ros-Lehtinen plainly says this bill “fails to prove for the needs of my constituents” and has the “potential to severely harm the health and lives of people in South Florida.” Read her statement and see why she isn’t just a no, she’s a HELL NO:

“Despite amendments and changes, the AHCA still fails to provide for the needs of my constituents. I will not support a bill that has the potential to severely harm the health and lives of people in South Florida and therefore I remain steadfast in my commitment to vote NO on the AHCA. The recent addition of further funds to high risk pools continues to be inadequate and fails to cover those who need it most. If enacted, the older and poorer South Floridians will be worse off and will find it more difficult to obtain quality healthcare. My constituents should not have to take a step backward in their ability to obtain treatment for any illness and thus, I will vote NO.”

Too bad her colleagues are caving right and left, ignoring the will and the needs of their constituents. The midterm elections take place on November 6, 2018. We have 551 days to get these bums out of Congress and restore our health care protections.

Here’s what you need to know about preexisting conditions in the GOP health plan

Washington Post, Fact Checker

Here’s what you need to know about preexisting conditions in the GOP health plan

By Glenn Kessler May 4, 2017

Inside the messy, last-minute rush for the GOP health-care plan

With House Republicans prepared to take a vote Thursday on yet another version of a plan to overhaul the 2010 Affordable Care Act, attention has been especially focused on whether Obamacare’s popular prohibition against denying coverage based on preexixting medical conditions will remain in place. Republicans, from President Trump to lawmakers pushing for the bill, insist that it remains intact, just in different form. Democrats and opponents of the bill say the guarantee is gone or greatly weakened.

The reality is more nuanced and complicated, as is often the case in Washington policy debates. Despite Ryan’s tweet that people with preexisting conditions are protected, there is no guarantee that they will not face higher costs than under current law. The impact of recent tweaks to the proposed legislation is especially unclear because lawmakers are rushing ahead without an assessment by the nonpartisan Congressional Budget Office. So here’s The Fact Checker’s guide to the debate.

What’s the issue?

Before the Affordable Care Act, insurance companies could consider a person’s health status when determining premiums, sometimes making coverage unaffordable or even unavailable if a person was already sick with a problem that required expensive treatment. The ACA prohibited that, in part by requiring everyone to purchase insurance.

But that “individual mandate” was unpopular and Republicans would eliminate that requirement in their proposed American Health Care Act. As a replacement, the AHCA initially included a continuous coverage provision that boosted insurance rates by 30 percent for one year if he or she has a lapse in coverage. (We explored this interaction between the provisions earlier.)

As part of an effort to attract more votes, Republicans have added an amendment, crafted by Rep. Tom McArthur (R-N.J.), that instead allows states to seek individual waivers from the law. One possible waiver would replace the continuous coverage provision so that insurance companies for one year could consider a person’s health status when writing policies in the individual and small group plan markets. Another possible waiver would allow the state to replace a federal essential benefits package with a more narrowly tailored package of benefits, again limited to the individual and small-group markets.

The theory is that removing sicker people from the markets and allowing policies with skimpier options would result in lower overall premiums.

Who would be affected?

If the law passed, a person generally would not be affected unless they lived in a state that sought a waiver. Moreover, they would need to have a lapse in health coverage for longer than 63 days and they would need to have a preexisting condition. Finally, they would have to purchase insurance in the individual market, i.e., the health exchanges in Obamacare that currently serve about 18 million Americans.

Someone who got their insurance from an employer – and that’s most Americans (155 million) – presumably would not be affected, though the CBO did project that under the initial version of the AHCA 7 million fewer people would be covered by employers than under current law by 2026.

Then, for a period of one year, a person who fell into this category would face insurance rates that could be based on their individual condition. But states that seek a waiver are required to operate a risk mitigation program or participate in what is called an invisible risk sharing program. Alaska currently has such a program that helps cover the bills for one of 33 conditions (such as HIV/AIDS or metastatic cancer). The individual with the condition still submits bills to the insurance company, which then turns around and bills the state. But then the insurance company does not consider the cost of this care as part of its calculation for premiums to other individuals in the state.

All told, the AHCA would allot $138 billion over 10 years for a variety of funds that would seek to keep premiums lower or to assist with cost-sharing. Just this week, $8 billion over five years was added to the pot to woo wavering lawmakers, with the idea that the additional funds could be used for so-called high-risk pools. Many states had such pools to help people with preexisting conditions before the ACA. But the proposal does not require a state with a waiver to set up such a pool.

What could go wrong then?

There are many uncertainties about this path. The health insurance market has a lot of churn, so many people may experience a gap in coverage of just a few months. One estimate, by the Commonwealth Fund, indicated that 30 million adults would have had such a gap in 2016, potentially exposing them to a surcharge or being placed in a high-risk pool. On top of that, the Kaiser Family Foundation estimated that 27 percent of the people in the individual market have existing conditions that would have been uninsured before the ACA.

The AHCA eliminates cost sharing and offers a stingier tax credit to defray premium costs, likely resulting in higher overall health costs that may make insurance unaffordable for many people. (The CBO projected that 24 million more people would be without health insurance than under current law by 2026.)

Then, if people get sick, they may suddenly find themselves for a year being priced on their illness if they live in a state that sought a waiver. Depending on the approach taken by a state, some people might find it difficult to keep up their coverage for a full year before they qualify for prices at the community rate.

A big question is whether the funding to cover these folks is adequate. High-risk pools were big money losers and underfunded in the pre-Obamacare days, even though many had restrictions, high premiums and waiting lists. A $5 billion federal pool, established by the ACA as a bridge to the creation of the exchanges in 2013, covered about 100,000 people but was suspended when it ran out of money.

The Center for American Progress, a left-leaning group that opposes the AHCA, produced an analysis that indicated that even with the additional $8 billion, the maximum enrollment the AHCA’s funds would cover is about 700,000 people. If just 5 percent of the people currently in the individual market ended up in high-risk pools – and all states sought a waiver – that would overwhelm the proposed funding.

Avalere Health, a consulting firm, said in an analysis that $23 billion is specifically allocated in the bill for helping people with pre-existing conditions. That would cover about 110,000 people. If states allocated all of the other available funding, that would cover 600,00 people. “Approximately 2.2 million enrollees in the individual market today have some form of pre-existing chronic condition,” the analysis said.

When states had high-risk pools, people in those pools represented just 2 percent of the non-group health insurance participants. But given the limitations of those funds, that percentage may not be a good guide for what would happen under the AHCA.

Whenever health-care laws are changed, there are unknown and unintended consequences. The current system does not take into account a person’s health status when assessing premiums. But, as a Brookings Institution analysis suggested, under the AHCA’s provisions, healthy people might have an incentive to join plans based on health status. That would leave sicker people in the community rated plans, which in turn would face higher premiums. Over time, that could make the community rating meaningless. Another possible outcome: If the pool of money is used to pay insurance companies for the difference in costs for patients with preexisting conditions, there may be little incentive for companies to keep their prices low; the difference would be made up by U.S. taxpayers.

The Bottom Line

When it comes to health care, readers should be wary about claims that important changes in health-care coverage are without consequences and that people are “protected” – or that the changes will result in massive dislocation and turmoil. There are always winners and losers in a bill of this size. In this case, if the bill ever became law, much would depend on unknown policy decisions by individual states – and then how those decisions are implemented.