(TFC) – Never has the term “under siege” so aptly fit the situation of any law as it does president Trump’s crusade against Obamacare.
While the stubborn American Care Act has outfoxed the GOP at every turn thus far like the proverbial animated roadrunner teasing Wile E. Coyote, conservatives might be adopting a change of tactics that is both effective and a perfect example of the disdain for ethics and procedure this congress repeatedly demonstrates.
In states like Idaho, the ACA marketplace admittedly leaves much to be desired for many demographics. But Idaho has found a workaround — ignore the ACA.
I Reject Your Reality and Substitute My Own
Technically, a law must be repealed before the mandate for the government to enforce it goes away. The American Care Act disallows insurance providers from factoring pre-existing conditions into insurance product costs. Now, however, Idaho is giving insurers the green light to offer products that include stipulations for pre-existing conditions.
Obamacare and Pre-existing Conditions
Obamacare puts tremendous emphasis on pre-existing conditions because of the way insurers have used them to manipulate product offerings in the past. They allow insurers to effectively dodge any requirement to provide coverage for persons who might have been born with a health disorder or suffered an injury.
In the original Obamacare proposal, there was to be a public health provider option that would force marketplace insurers to remain competitive. When that didn’t happen, the hope was that there would still be competition, but as more insurers have withdrawn from marketplaces, situations like Idaho’s — where the few options available through the market are overpriced for many people — are manifesting in many states.
Working Around the ACA
The individual mandate would have forced Idahoans to subscribe to the high-priced policies or suffer legal repercussions. However, the GOP has essentially nullified that portion of the ACA. Technically, people are still required to have healthcare. However, Trump’s administration will not be enforcing any violations of the policy.
For the same reason, Idaho insurers can get away with offering products that include what is known as “underwriting.” By definition, the practice involves taking into account a person’s medical history before quoting their premiums for a health care plan. Cheaper premiums are available for those without pre-existing conditions.
It’s worth noting that the marketplace would not cease to exist in Idaho. Dean Cameron, director of the Idaho Department of Insurance, stated in an interview with KHN that “Our goal is not to take away from the ACA, but to add to it or complement it.” That sounds well-meaning, but it sets a dangerous precedent that could lead to Obamacare unraveling further before lawmakers can create a replacement system.
Obamacare on Thin Ice
The reason that Idaho can defy the ACA so blatantly and get away with has to do with the department responsible for enforcing ACA violations. That is the U.S. Department of Health and Human Services, which is under the direct control of the executive branch.
That means Idaho might not be the last state to employ this approach. Officials at the DHHS could hypothetically be reprimanded for failing to enforce the law, but the smart money is on Trump choosing to turn a blind eye. That could create a chain reaction. Other states would begin defying the ACA, and soon, the country would be in insurance anarchy.
When that happens, there is no guarantee that any semblance of the ACA will continue to function as intended. You could see the elderly, the poor and the unemployed unable to receive benefits. Although not directly tied to the marketplace options, public health services like Medicaid could suffer as well.
The ACA’s Last, Best Hope
However, not all states where this can happen are states where it will likely happen. One of the few upsides to our divisively partisan political climate is the fact that liberal states that want to see the ACA live on will probably not allow this. There will be pushback at the local level.
That could be enough to keep a complete breakdown of the ACA from occurring, but we must acknowledge that people need care and the current system is not working for them.
Instead of finagling an unplanned, anarchistic market that only benefits insurers, why can’t our government make some compromises and deliver a plan that works? When the executive branch ceases to carry out the laws that we need for society to function, it has failed to do its job, and that’s what we’re seeing now.
Idaho’s model can’t be allowed to spread. If you live in a state where this could happen, write your congressman, get involved and speak out for the rule of law. The sick, elderly and impoverished are depending on it.