Trump’s health care plan exposes the truth about his “populism”

“Vance’s sunny rhetoric here disguises his plan’s inegalitarian moral priorities.
It is true that the young and healthy have different medical needs than the old and sick. And before the Affordable Care Act’s regulations, the former could sometimes procure cheaper insurance tailored to their (currently) limited needs.

But this came at a social cost. Insurers were able to offer cheap health coverage to those who barely needed it by screening out those with preexisting conditions. In Vance’s terminology, they constructed low-risk pools: By only including people who were unlikely to require expensive treatments in their plans, they could profitably provide low-premium insurance to the young and well.

Meanwhile, sick and/or older Americans on the individual insurance market either went without coverage or were forced to pay dramatically higher premiums in order to cover the high cost of their care. Some state governments tried to defray this cost somewhat by subsidizing high-risk pools. But enrollees still paid much higher premiums than the typical market rate, and their coverage often excluded the treatments they needed most.

The Affordable Care Act effectively forced the healthy to subsidize the sick. It required insurers to include those with preexisting conditions in their plans and cover all medically necessary procedures. To guarantee that insurers could still turn a profit and that coverage remained (at least somewhat) affordable for all, the government provided consumers with insurance subsidies.

The upshot of all this was that coverage became a little more expensive for some healthy people, while growing much cheaper for the old and seriously ill.”

“Vance’s vision for health care policy helps clarify the character of the right’s burgeoning “populism.” On trade and immigration, Vance’s ideology may prize a nationalistic conception of the common good above free markets. But on most economic questions, its iconoclastic rhetoric belies its fealty to conservative orthodoxy — and thus, to “the ruling class” whom Vance loves to deride.

As Trump’s running mate, Vance is campaigning on tax cuts for corporations and the wealthy and deregulation for health insurers. The rest of Trump’s economic agenda is rather hazy. But if his first term is any guide, it would also involve curtailing workers’ collective bargaining rights, reducing workplace safety standards, and attempting to throw millions off of Medicaid. Vance has not seen fit to criticize any aspect of this record.”

“For Vance, deregulating insurance markets at the expense of the vulnerable is not neoliberal or anti-populist. But arguing that politicians should not spread incendiary lies about immigrants is.”

https://www.vox.com/politics/372635/trump-health-care-plan-vance-preexisting-conditions

California Is Trying To Drive Landlords Out of Business

“What do the state’s insurance and housing crises have in common? Obviously, homeowner policies have an impact on housing costs, but I’m referring to something different, namely the concept of open-ended risk. Insurers are exiting the market because state policies limit their ability to price policies to reflect the risk of a major wildfire season. They rather pull out of California than risk the destruction of their assets.
I’d argue the same thing is happening in the rental market, thanks to a fusillade of pro-tenant laws that subject landlords to an incalculable level of risk. Landlords have freely entered the business and understand the various ups and downs. They can calculate the costs of mortgages, taxes, insurance, and maintenance. They expect to, say, replace carpets and paint between tenants. They know the cost of the eviction process in those instances where it’s necessary.

But the Legislature’s anti-property-rights crusade—done in the name of protecting tenants in a tight housing market—has not only increased those easily calculated costs, but also the costs that are potentially devastating. It’s one thing to realize it might require x-number of legal fees to remove a bad tenant and quite another to wrap one’s head around the possibility of someone staying in a rent-controlled unit forever.”

https://reason.com/2024/04/19/california-lawmakers-are-trying-to-drive-landlords-out-of-business/

California Won’t Let Homeowners Insurance Companies Raise Rates, so They’re Leaving the State Instead

“The state’s leaders are acting like this is some unexpected perfect storm, but it’s one that’s been on the horizon for several years. “California’s one-two punch—forcing companies to write risky policies while also limiting their ability to charge market rates—would leave insurers with little choice but stop writing new policies,” I wrote in 2021. Last March, I warned insurance companies are “quietly fleeing” the state. Two months later, they stopped being quiet about it. In May, State Farm announced its freeze on writing new homeowner policies.”

https://reason.com/2024/03/29/california-wont-let-homeowners-insurance-companies-raise-rates-so-theyre-leaving-the-state-instead/

Fixing open enrollment starts with staying mad about it

“Almost four in 10 Americans — 38 percent — said that in 2022 they had put off medical care because of the cost, per Gallup. That is the highest number ever recorded since the polling firm started asking the question in 2001. Another survey, from KFF over the summer, found 28 percent had difficulty affording prescription drugs.
The truth is that insurance alone isn’t always enough to help people afford health care. The Commonwealth Fund concluded that 43 percent of Americans had been “inadequately insured” in 2022. That meant either they had been uninsured, had a gap in coverage during the year, or the insurance they had would not be adequate if they had an expensive medical emergency or diagnosis — for example, if their plan’s out-of-pocket costs could exceed 10 percent of their household income.

More than 40 percent of people said they had skipped care due to its cost, or they had trouble paying off medical bills, medical debt, or both.

It does not have to be this way. There is not one specific prescription for fixing health care. Countries have found various ways to make health insurance more affordable, standardized, and universal”

https://www.vox.com/policy/2023/10/16/23894085/health-insurance-open-enrollment-medical-dental-medicare-obamacare

‘The rule has sticks as well’: Biden’s getting tough with health insurers

“the White House points to a 2022 report to Congress from the Health and Human Services, Labor and Treasury departments, which found that not one of the 156 insurance plans and issuers studied were following rules requiring them to measure their compliance with the 2008 law.
The problem is actually quite simple, advocates of the Biden rules say.

“The insurers are cracking down on mental health reimbursement in order to save money,” said Sen. Chris Murphy (D-Conn.).”

“Estimates vary, but the latest data from HHS indicates that more than half of adults with mental illness don’t get treatment. Treatment levels may be even lower for substance use conditions like opioid use disorder”

“The new proposed regulations, from HHS and the Treasury and Labor departments, are open for public comment until Oct. 2.

If finalized, they would mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes.

The companies would have to look at how they respond to requests from doctors to authorize treatments for mental illness, compared with physical ones, as well as audit their provider networks and examine how much they reimburse providers out of network.

“This is something that you would have expected the issuers and plans to be doing as part of their own internal analysis to ensure compliance,” said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.”

“Insurers say they agree that access to mental health care should be equivalent to that of physical health care.

But AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out, and that workforce shortages are what’s behind barriers to care.

“Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access,” AHIP spokesperson Kristine Grow said in a statement.

The group said those include boosting telehealth coverage and integrating physical and mental health care. And it points to rising mental health care usage since the 2008 law as evidence that the law is working.”

https://www.politico.com/news/2023/09/17/white-house-insurer-mental-health-law-00115804

Subsidized Flood Insurance Makes Storm Damage Worse

“The National Flood Insurance Program (NFIP), managed by the Federal Emergency Management Agency, was created in 1968 to help homeowners in flood-prone areas afford insurance. Federal law requires that mortgaged properties in designated flood hazard areas carry flood insurance, but insurance premiums in oft-flooded areas are significantly more expensive (if they’re even offered at all). The NFIP offers federal backing for policies that private insurers would not otherwise touch or that would be too expensive for most people to afford.”

“providing insurance to an otherwise uninsurable market comes at a price: A 2011 report by the nonpartisan Government Accountability Office (GAO) found that 22 percent of NFIP’s policies were issued at subsidized rates, about 40–45 percent of the cost of an unsubsidized policy. Between 2002 and 2013, the NFIP collected between $11 billion and $17 billion fewer in premiums than the market would have dictated.
As a result of charging premiums below market rate, the NFIP often runs over budget”

“The policies themselves don’t make financial sense. NFIP policy holders are not limited in how many claims they can file or how much money they can receive. As a result, more than 150,000 properties nationwide have flooded multiple times and received NFIP reimbursement each time.”

“An insurance company’s refusal to provide coverage in a high-risk area provides a disincentive to anyone who chooses to live there: When the inevitable happens, you’ll be responsible for the damage yourself.

But when the government assumes the risk on an insurer’s behalf and makes insurance cheaper than the market would dictate, it creates incentives for people to live in dangerous areas more likely to be battered by extreme weather events.

There is evidence that NFIP’s artificially cheaper policies have done exactly that. A 2018 study by Abigail Peralta of Louisiana State University and Jonathan Scott of the University of California, Berkeley, found that after a county joins NFIP, its relative population “increases by 4 to 5 percent” as residents stay in high-risk areas as opposed to moving away.”

“Two decades ago, John Stossel relayed the story of his beach house in the Hamptons, built on the edge of the water and insured for just a few hundred dollars a year through NFIP. It was fully or partially rebuilt multiple times over the years before finally getting washed away in a storm, with taxpayers footing the bill each time.

As the 2023 hurricane season gets underway, it’s high time for Congress to end the NFIP—a program that goes billions of dollars into debt providing subsidies to keep mostly wealthy people living in high-risk areas.”

https://reason.com/2023/08/30/subsidized-flood-insurance-makes-storm-damage-worse/