Health Care

The TrumpCare “Fix” We Warned You About: the Ted Cruz Amendment


Mitch McConnell ran into a problem when he put out the first draft of the Senate TrumpCare bill in June. Even though the bill was too conservative for a handful of moderate Republicans, it wasn’t conservative enough for the most extreme wing of the caucus.

But McConnell isn’t giving up trying to thread this needle. He needs the extreme conservatives on board if he has any chance of jamming the TrumpCare bill through the Senate. He’s hoping moderate Senators will accept the Cruz amendment and think of it as a “compromise” or a “fix” that unlocks the magical path to 50 votes through a thorny Republican caucus. Ted Cruz himself says his amendment is “the key to getting 50 votes.”

Here’s the thing: the Cruz amendment is not a compromise. It is not a fix. It makes TrumpCare even worse. It’s purpose is to appease the most conservative Republican senators, which means it is necessarily more harmful and destructive. There is no way your Senator should support it.

WHAT THE CRUZ AMENDMENT DOES

Eliminates patient protections. Currently health plans sold on the marketplace have to cover different types of care called “essential health benefits.” Essential health benefits include hospitalization, outpatient care, emergency services, maternity care, mental health, prescription drugs, lab work, rehabilitative services, and others.

Even though these types of care are extremely important, conservatives like Ted Cruz think requiring all of these services to be covered drives up premiums. He’s zeroed in on maternity care and mental health in particular, but it is just not true that maternity care and mental health contribute significantly to the costs that drive premiums. Nevertheless, Ted Cruz and the conservatives want to make those types of services harder and more expensive to get in the name of “freedom.”

His amendment would allow insurance companies to sell plans that have fewer benefits and patient protections, as long as they sell just one plan that complies with the ACA requirement to cover essential health benefits.

What does that do? Death spiral! It means that people who are relatively healthy and don’t expect to become sick or pregnant will gravitate to skimpier plans that don’t cover as much and as a result don’t cost as much. It also means that people who are less healthy will gravitate to plans that cover the services they actually need. This separates people into two systems of insurance: one for healthy people, and one for people who are sick, expect to become pregnant, or had a health issue in the past. That is an insurance market doomed for failure—it would create a classic death spiral.

THE CRUZ AMENDMENT IS BAD FOR ALL AMERICANS

It discriminates against people with pre-existing conditions. The Cruz amendment takes away a key protection that exists today: people with pre-existing conditions are guaranteed access to an affordable plan that covers their pre-existing conditions. Under the Cruz amendment, they would only have bad choices, if they had any choice at all. They could buy a cheap plan that doesn’t cover the services they need and pay out of pocket for those services. Or they could buy a plan that is much more expensive than what they have today, if they’re lucky enough to find a plan that covers what they need. Either way, costs go way up for people with pre-existing conditions.

It sets people up to be unpleasantly surprised. It also drives up the cost for people who have unexpected medical needs that bought a skimpy plan. Since insurance companies will sell mostly minimalist plans, if someone suddenly has a medical emergency and requires more care than they expected, they will see tremendously high costs. They could be surprised to find that a specialist they saw was out of network, that much of their care has to be paid out of pocket, or that their insurance only covers a small percentage of the services they needed.

It will create confusion. Right now, if you buy a plan through the marketplace, you know you’re well-protected since they’re required to cover essential health benefits. If insurers are allowed to start selling plans that don’t cover even basic services, it will take a lot more work for patients to understand the plan they have and what is covered. Right now, you can assume hospitalization is covered by your plan. Under the Cruz amendment, you could make no assumptions about hospitalization or anything else.

It’s wasteful. Many Americans get help affording health insurance through tax credits. Those tax credits are used to help buy plans that cover a set of services. While TrumpCare still offers tax credits (albeit in lower amounts), the plans these tax credits help buy won’t cover as much, meaning tax dollars will be used to help people buy plans that don’t meet their needs.

THE BOTTOM LINE

The Cruz Amendment makes TrumpCare worse because it hurts people with pre-existing conditions and takes away key protections for patients that keep insurance companies in check. It is not a compromise and it is not a fix. If your Senator tries to tell you they “fixed” the bill by adding the Cruz Amendment, tell them they couldn’t be more wrong and that they should vocally oppose it.

SAMPLE CALL DIALOGUE

Caller: Hello! My name is [name] and I’m calling from [part of state]. Can you please tell me how Senator [name] intends to vote on the Better Care Reconciliation Act?

Staffer: There is no vote currently scheduled on that bill.

Caller: Yes, but I’m sure the Senate will vote as soon as they can. How will Senator [name] vote on the bill?

Staffer: He/she [hasn’t taken a position on the bill yet] [said last week he/she will not support the bill in its current form. He/she has serious concerns.]

Caller: Senator [name] needs to oppose the TrumpCare bill no matter what. There’s nothing he/she can negotiate with Mitch McConnell that would make this bill something he/she should support. I’m also strongly opposed to the new proposal from Ted Cruz regarding what kind of plans can be sold in the marketplace. Do you know if Senator [name] supports that proposal?

Staffer: I’m not sure.

Caller: That proposal would make things even worse for people with pre-existing conditions. It says that insurance companies can sell whatever plans they want -- no matter how low-quality they are -- as long as they sell just one plan that meets the ACA’s standards. That is a waste of taxpayer dollars because it means people will use tax credits to buy plans that don’t cover anything. And even worse, it means prices will go way up for people with pre-existing conditions.

Staffer: This bill protects people with pre-existing conditions.

Caller: That’s not true. The bill allows states to let insurance companies sell plans that don’t cover essential health benefits, meaning people with pre-existing conditions won’t be able to get the care they need. And the new proposal from Ted Cruz makes it even worse. It basically creates two insurance markets: one for healthy people, and one for sick people, people who expect to become pregnant, or people who had a health issue in the past. And it will cause unnecessary confusion for anyone trying to buy a new plan.

Staffer: The Senator is waiting for a new CBO score to make a decision on the bill. CBO is scoring the bill with the Cruz proposal and without it.

Caller: I see. Well I want Senator [name] to oppose this bill whether it has the Cruz proposal in it or not. There is no change -- not extra time, not extra funding, no policy tweak, and definitely not this Cruz proposal, that could make this bill something Senator [name] should support.

Staffer: I’ll be sure to pass along your thoughts to the Senator.

Caller:  Thank you. Please take down my contact information so you can let me know how the Senator decides to vote on this bill.