Expert On This Week Explains How Trumpcare Funds Tax Cuts For Rich By Cutting Health Care Subsidies

Dr. Atul Gawande: High-Risk Pools Have “Waiting Lists, Poorer Coverage, And High Costs”

From the May 7 edition of ABC's This Week with George Stephanopoulos:

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GEORGE STEPHANOPOULOS (HOST): Now, we know what happened with the House bill. They were basically giving the states the option to waive the requirements so people could be charged higher premiums who had pre-existing conditions. They also added some money to pay for that. The president looks at all that and says that the coverage for pre-existing conditions will be the same now as it was under Obamacare. Your response? 

ATUL GAWANDE: Well, it's hard for me to watch that Jimmy Kimmel clip because my own son, who is in his twenties and has almost the same heart condition, when he turns 27, he has to go out on a market. And most of the jobs he has had are freelance jobs with no benefits. He's like 1 in 4 Americans that are with histories of cancers, diabetes, or heart conditions. And my worry as father, as a cancer surgeon, is that when we say we're going to put people into high-risk pools, we have seen what that is. High-risk pools are separate insurance plans for people with pre-existing conditions. And they've historically had very low coverage, waiting lists, poorer coverage, and high costs. It's chilling to imagine my telling my son those are where he would end up going or my own patients. 

STEPHANOPOULOS: And then the medicaid savings: about $880 billion in savings according to the Congressional Budget Office. 

GAWANDE: Right, it cuts the 70 million people on medicaid by about a quarter, and for he rest of the people, there's a cap. Whether it's the elderly in nursing homes, people who are working poor. The cap would mean that the coverage becomes limited. 

STEPHANOPOULOS: And then, finally, because of the way that they affect the subsidies, some older and sicker Americans will be paying more. 

GAWANDE: Yes. People who are over 50 can be charged under this new bill up to five times more than younger people. 

STEPHANOPOULOS: But how about if you take the flip side? It's very clear right now for a lot of younger and healthier Americans, their premiums have gone up under Obamacare. We have also seen insurance companies facing losses. A lot of insurance companies facing losses in states most recently like West Virginia and Iowa. Big insurance companies pulling out of those states. That fuels the president's argument, the speaker's argument that Obamacare is collapsing. 

GAWANDE: So, the core thing that's happening is that there's uncertainty in the market about will there be subsidies? Will there be mandates? And so, the insurers don't know how to price and are pulling out. Here's the thing to understand is that this is not -- this is a bill that makes each measure of health and health care worse, rather than better than under Obamacare. It's not a proposal that anybody would put forward as a credible or sane proposal for solving the problems in Obamacare. 


GAWANDE: Well, the core reasons are, number one, it doesn't have the subsidies. So, by cutting the subsidies substantially, we're taking $1 trillion away from support for people's health care in the bottom 40 percent and returning it as a tax cut to the top 2 percent. So, you take a trillion dollars of support out of health care where it's ending income-based subsidies. turning them into age-based subsidies, and that ends up hurting people across the board, especially in that bottom 40 percent. 


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