21st-Century Health Insurance

President Donald Trump said he would "make health insurance available to everyone" when he addressed Congress on Tuesday night.

Trump asked Congress to "repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care."

The Affordable Care Act, the formal name for Obamacare, set 21st-century standards for coverage. For a "Trumpcare" plan to succeed, it must equal the 2010 act's rigor.

The standards protect people with insurance obtained through employers, as well as plans obtained via Obamacare.

With Trump's challenge to Congress on Tuesday, he crossed the starting line with his campaign promise to kill Obamacare and replace it with something superior. Despite his rush, the race could prove long.

First, the president and Congress must produce a detailed plan. The people should examine each point deeply.

They should demand of their representatives and senators no slippage in coverage. That has been the case with previous congressional plans.

STANDARDS

Health insurance in the United States must continue to cover:

  • People with pre-existing conditions. (Trump called on Congress to do so.)
  • Dependents, typically adult children on parental insurance, until age 26.
  • Patients beyond the time of an illness. Coverage cannot be dropped for getting sick.
  • Medical costs, regardless of total cost — no coverage caps.
  • Medical expenses up to an annual limit on patient payments. This year, the caps for out-of-pocket costs are $7,150 for an individual and $14,300 for a family.
  • Mental health, substance abuse and behavioral-health treatment at the same rate as for general medical care — at parity. This includes psychotherapy and counseling.
  • Preventive care, without cost sharing — insurance covers the full cost. This includes screenings and vaccines.
  • Emergency care. The cost for out-of-network emergency care is charged at no more than the cost for emergency care within an insurance plan's network of doctors and hospitals.
  • Ambulatory care. Commonly called outpatient care, this is health care that does not require hospitalization.
  • Chronic-disease management. Such management coordinates care for ongoing disease. It includes screenings, checkups and related education for the patient. Among its aims is limiting the effects of a disease on the patient.
  • Hospitalization.
  • Laboratory services.
  • Maternity-and-newborn care, including for plans obtained after the mother becomes pregnant and for a newborn child added to a plan after birth.
  • Pediatric dental-and-vision care.
  • Prescription drugs.
  • Rehabilitative and habilitative services — to regain or gain health and ability.

Before Obamacare, many of these services were not covered by health insurance, or were covered partially or at extra cost.

Some members of Congress favor repealing Obamacare without replacing it. The public would not stand for such selfishness, nor, it appears, would the president.

Trump's call for a replacement plan to guarantee health insurance for all people in the United States is important. Nonetheless, that is nothing more than what we have.

Trumpcare can cross the finish line and claim victory only if it includes or improves upon every aspect of 21st-century health insurance.

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