- Senate Democrats forced a vote to roll back the Trump administration’s new rule expanding the use of short-term, limited-duration health insurance plans on Wednesday.
- Short-term, limited-duration plans are cheap alternatives to Obamacare marketplace plans.
- But they lack key protections for Americans with preexisting conditions.
- Democrats say the expanded use of short-term plans would harm people with preexisting conditions, while the GOP argue expanding the plans gave consumers more choice.
- The vote ultimately failed, but bringing the preexisting condition issue to the forefront could still be a win for Democrats.
Senate Democrats failed to push through a key healthcare vote on Wednesday, but in defeat looked toward a boost in their midterm election prospects.
Sen. Tammy Baldwin used a procedure called a discharge petition to force a vote that would have repealed President Donald Trump’s plan to expand short-term, limited-duration health insurance plans – which Democrats called “junk” plans.
The petition ultimately failed in the Senate by a vote of 50-50, with GOP Sen. Susan Collins crossing party lines to vote with Democrats.
But Democrats may still have gotten a big win from the vote.
In the run up to the midterm elections, Democrats are hammering the GOP on healthcare – particularly protections for people with preexisting conditions. And the stark divide between the two parties in the petition vote could give add another wrinkle to the fight.
Preexisting condition protections vs. consumer choice
The discharge petition was designed to roll back a regulatory change from Trump’s Department of Health and Human Services. The rule change allowed the expanded use of short-term, limited-duration health insurance plans.
These plans are cheaper but also less generous in what they cover. Under the Affordable Care Act, or ACA, the use of short-term plans was limited to three months and were generally used by people as a bridge in case of a job loss.
The new Trump rule would allow Americans to stay on the short-term plans for up to 12 months and allow renewals for up to three years.
Health policy experts say the problem with these plans is that they do not have to abide by the ACA’s basic coverage rules:
- This means that while insurers can’t deny people short-term plans based on a preexisting condition, they can charge more for people who are sick and possibly even price those people out of the market.
- The short-term plans do not need to abide by the ACA’s essential health benefits rules, which force all insurance plans to offer baseline coverage like prescription drug payments and maternity care.
- Experts warn that the short-term plans could pull healthier, younger people out of the ACA market. That would leave a more expensive pool of people in the Obamacare marketplace, potentially pushing up prices for everyone.
- Win McNamee/Getty Images
Democrats argued the expansion of these plans will undermine preexisting condition protections and harm sicker Americans.
Sen. Joe Manchin, a moderate Democrat facing a tough reelection race in West Virginia, supported the petition.
“I am fighting to ensure that every West Virginian with preexisting conditions, and those who may someday have a pre-existing condition, cannot be denied healthcare coverage or be charged more for their coverage,” Manchin said in a statement after the vote.
While Democrats hammered the issue as a vote on preexisting conditions protections, Republicans cast the discharge petition in a very different light.
To Republicans, the short-term healthcare plans were about consumer choice.
“We don’t need more command and control, more paternalism out of Washington that thinks it knows what’s best for you,” said Sen. John Cornyn, the second-highest ranking Republican. “We need more choices for consumers so they can buy healthcare at a price they can afford and that suits their needs.”
Others like Sen. Ron Johnson argued that the short-term plans do not undermine Obamacare’s preexisting condition protections.
“The rule expands affordable options and leaves Obamacare plans’ pre-existing conditions provisions untouched,” Johnson said.
While it is true that the plans don’t eliminate the ACA’s preexisting conditions provisions, it would undermine them for people on the plans. According to the Congressional Budget Office, 1.6 million in the first four years under the rule would be on those types of plans without protections.
Collins, the lone GOP vote for the petition, framed preexisting conditions as the decisive factor in her vote.
“Short-Term Limited Duration plans do not provide protections for enrollees who suffer from preexisting conditions,” Collins said. “As I have often emphasized, it is essential that individuals who suffer from preexisting conditions are covered.”
A political winner?
Polling shows that protections of people with preexisting conditions are important to voters.
According to a poll by the Kaiser Family Foundation, a nonpartisan health policy think tank:
- 75% of people surveyed said protections to ensure people are not denied coverage due to a preexisting condition are “very important.”
- 72% said ensuring people are not charged more because of preexisting conditions is very important.
- 56% of Republicans polled by Kaiser said protecting sick people from being charged more from insurance was important.
- Another poll, from Morning Consult and Politico, found that 81% of voters said that it should be illegal for insurers to deny people coverage due to a preexisting condition.
- 71% said it should be illegal for insurers to charge more.
And more people said they trusted the Democratic Party to ensure those protections: 42% of people surveyed by Morning Consult/Politico said that they trust Democrats to protect people with preexisting conditions, while only 20% preferred Republicans.
It’s obvious Democrats know their advantage. Roughly half of all ad spending by Democratic midterm candidates or groups focuses on healthcare, far and way the largest focus for the party.