As voters worry about health care, Trump administration relaxes Obamacare rules

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• Judy Woodruff:

  Now to the latest battle over Obamacare, or the federal health care law formally known as the Affordable Care Act.

  The Trump administration announced yesterday that it will allow states to go ahead with the sale of cheaper and skimpier health insurance plans. But some of these do not have to cover preexisting conditions, something that had previously been a legal requirement of Obamacare.

  And, as William Brangham tells us, that could play right into a major election fight over that issue.

• William Brangham:

  Yesterday, the Trump administration gave states new flexibility with their health care plans, allowing them to use federal subsidies for cheaper plans that come with fewer required benefits.

  For example, they can now subsidize plans that don't have to cover prescription drugs or mental health or maternity care, all things that the Affordable Care Act required.

  And these plans could also deny coverage to people with preexisting conditions, as long as consumers still had access to another, more comprehensive plan that guarantees that coverage.

  These sound like small changes, but they're not. And they will take effect starting in 2020.

  President Trump and many Republicans contend these new options are exactly what some consumers want. But this comes as support for parts of Obamacare are growing. And at least one recent poll found a majority of voters say health care is very important in making their decisions come November.

  Margot Sanger-Katz covers all this for The New York Times. And she joins me now.

  Welcome back.

• Margot Sanger-Katz:

  Thank you for having me.

• William Brangham:

  So, help us understand what the Trump administration announced yesterday. What are these changes and what do they mean?

• Margot Sanger-Katz:

  So, this is something that was always in Obamacare. There's a provision that allows states to apply to do a totally different system if they want, but they have to adhere to certain guardrails to make sure that they're not taking coverage away from people who would have otherwise gotten it.

  And the Trump administration put out new rules for that process, where they basically said, we are going to be much more open-minded about letting states throw out all the Obamacare rules and come up with their own way of managing their insurance marketplaces.

  So this could include allowing plans that cover fewer benefits, maybe don't cover prescription drugs or mental health care. They are also including plans that maybe are not available to people with preexisting conditions, or not available to them at the same price as for other customers, and all kinds of other changes.

  Maybe the — who get the subsidy for what could change. So we don't know what the states are going to do. But states are now welcome to bring these proposals forward. And the Trump administration has said that they are open to approving them.

• William Brangham:

  And is the concern that, if federal subsidies now could be seen as another encouragement to people to buy these plans, that people might be getting a plan that they think covers them, but then when a crisis hits, they don't really have coverage?

• Margot Sanger-Katz:

  Yes, I think there are two concerns. And they're both important.

  So one is just that, that people may buy a plan, and they're healthy when they buy it, and they don't really understand the fine print, and they think it's a good plan, and then, boom, their kid gets an illness or they develop cancer or a drug addiction and suddenly when they realize that they need those benefits, that they're not there.

  So there is that concern, that these plans that cover fewer things, that have more exclusions could have holes for individual consumers.

  And then I think there's a broader concern, which is that kind of cheaper plan that covers less, that might be good for someone who is healthy and never has any health conditions and was never going to use their health insurance anyway.

  But for someone who has a preexisting illness, they are never going to buy that plan. It's not going to be available for them. It's not going to cover the benefits that they need. And so what it does is it sets up these two side-by-side markets, where all of the people with preexisting conditions buy the sort of comprehensive Obamacare plans, and a lot of healthier people are willing to roll the dice on these cheaper plans.

  And what can happen is that, because the way insurance works is we're sort of all pooling our premiums together to cover our collective health bills, if you have one pool over here, where all the sick people are, and another one over here with all the healthy people, that the price for buying insurance for sick people could get really, really high.

  And that could make it unaffordable for a lot of people who really need insurance the most.

• William Brangham:

  As we have seen, there are people all over the country who are struggling to pay their bills. My colleagues were out in Idaho recently, and they met a young woman who is — basically can't afford health care. And she's desperate.

  She sounds like she'd be an ideal customer for a cheaper, maybe skimpier plan.

  Listen to what she had to say.

• Semele Freeman-Hall:

  I absolutely would try again for health insurance. And, actually, every year when the enrollment comes up, I try, hoping for a miracle that there's going to be a plan I can afford.

  I have never given up. I try every year. And then, every year, it hasn't worked out. So, absolutely, I would — I would look at it again. And if there's plans out as early as next week, I will look into it next week.

• William Brangham:

  I mean, this is a real issue for a lot of people.

• Margot Sanger-Katz:

  It really is.

  And I talk to these people all the time. It is true that Obamacare made health insurance a lot more affordable for low- and middle-income people. It made it more accessible for people with prior illnesses.

  But for a lot of people who make what we would consider to be middle-class incomes, who don't qualify for a subsidy, these insurance plans can be really expensive, and they can be unaffordable.

  And we know that those people have been dropping out of the market, and they're going without anything. And so I think that policy-makers in the Trump administration are trying to be sensitive to this population and say, OK, maybe these skimpier plans aren't quite as good, don't have all the same consumer protections and benefits as an Obamacare plan.

  But if people are choosing between this and nothing, isn't it better to give them something skimpier, and let them decide what's the right plan for them?

  Consumer advocates, I think, on the other hand are very concerned about people sort of falling through the cracks and again about the segmentation of the market.

  But I think that this person in Idaho is really speaking to a real problem that we see in the country, because health insurance is just so expensive. It's quite out of reach for a lot of people.

• William Brangham:

  On a separate, but related issue, the issue of preexisting conditions has become nationally a very big political issue in the lead-up to the midterms.

  I want to show you two excerpts of some ads that are running in Missouri, Senator Claire McCaskill and her opponent, A.G. Josh Hawley. Take a look at these.

• Sen. Claire McCaskill, D-Mo.:

  Two years ago, I beat breast cancer. Like thousands of other women in Missouri, I don't talk about it much, but those who face cancer and many other illnesses have a preexisting condition when it comes to health coverage.

  Unfortunately, Josh Hawley filed a lawsuit letting insurance companies deny coverage for those with preexisting conditions. That's just wrong.

• Josh Hawley:

  Earlier this year, we learned our oldest has a rare chronic disease, preexisting condition. We know what that's like.

  I'm Josh Hawley. I support forcing insurance companies to cover all preexisting conditions. And Claire McCaskill knows it.

• William Brangham:

  How did preexisting conditions become such a big issue in the midterm elections?

• Margot Sanger-Katz:

  I think the real answer is Obamacare repeal.

  So, as you may recall, over the last few political cycles, Republicans have really run on this message that they want to repeal and replace Obamacare.

• William Brangham:

  Which would get rid of coverage for preexisting conditions.

• Margot Sanger-Katz:

  It would. That was a really important part of Obamacare. It's not the only way that you could take care of these people. But it's the way that we do it now in our law.

  And when Republicans got really serious about repealing the Affordable Care Act last year, I think that suddenly this law that had been very controversial and had been pretty unpopular, people started to suddenly look at it differently.

  And we saw in the public opinion polls for the first time that more people supported the Affordable Care Act than wanted it repealed. And that is a shift that has persisted. We saw a lot of engagement by kind of Democratic activists, by disease advocacy groups, people who are lobbying on the Hill, organizing at home.

  And it has become this really central issue for Democrats, to say, we pass the Affordable Care Act, we're suddenly proud of it, and we are going to protect people with preexisting conditions.

  If you look around the country, this is the number one issue for Democrats. There are more ads on health care than any other subject. Polling has consistently shown that health care is, if not the most important issue, the second most important issue to voters, both in battleground states and all around the country.

  And I think Republicans now are kind of floundering a little bit to find what their answer is going to be to this problem. And we see a lot of ads now and statements from Republican candidates, like Josh Hawley's ad, where Republican candidates, even those who have voted for the Obamacare repeal proposal on the Hill or who, like Josh Hawley, are part of a lawsuit that would seek to repeal the Affordable Care Act through the courts, that they are saying, no, no, I'm still committed to preexisting conditions.

  I think it's a little bit hard to believe what they're saying, even though I think there are possible ways that they could achieve that, because they have not been very specific about how they would do it.

  And we have them on the record as being opposed to the way that Democrats have achieved it.

• William Brangham:

  All right, Margot Sanger-Katz, as always, thank you very much.

• Margot Sanger-Katz:

  Thanks again.