Under Healthcare 'Dystopia' Envisioned by Trump, Cash-Strapped Patients Would Take Out Loans From Insurers

After the Republican Party's decision to terminate subsidies that had significantly reduced healthcare costs under the Affordable Care Act for 22 million people, the White House is considering a new way to—officials claim—"help" Americans who face massive medical bills, either due to high-deductible plans that don't cover routine costs or because of emergency expenses.

The proposal, though, could just shift "who [the patients] owe the debt to," as one doctor and researcher told The New York Times, which reported Thursday on the Trump administration's proposal to allow people to take out loans directly from their health insurance companies when they can't afford to pay a hospital or doctor's office out of pocket—and then pay the insurance company back, likely with interest.

"Hard to top this level of dystopia," said one writer in response to the Times report. "Have health insurance through the ACA? The Trump administration is going to turn your health insurer into a loan shark you borrow money from if you can't afford to pay your portion of medical procedures."

As the newspaper was reported, the provision is buried in a 1,121-page final rule issued last month regarding how the ACA will be regulated next year.

The Trump administration is planning to significantly expand the number of Americans who are eligible for high-deductible "catastrophic" health insurance plans that provide no coverage for day-to-day medical expenses.

"We note that multiyear and 1-year catastrophic plans may be able to offer relief from the high deductible and maximum annual limitation on cost sharing through other mechanisms," reads the final rule. "For example, issuers of catastrophic plans could consider financing the deductible by providing enrollees a loan."

Currently, the average annual deductible for people insured under the ACA is nearly $4,000, and about 40% of enrollees this year have "Bronze" plans, which have an out-of-pocket maximum that's over $10,000 for an individual, likely leaving many people having to pay thousands of dollars in medical expenses despite having coverage.

By 2028, as Common Dreams reported earlier this year, catastrophic plans with lower premiums could have deductibles as high as $31,000 for families.

The plan to shift more people onto expensive plans that provide less coverage for day-to-day medical care—and to push patients to take out loans from their insurers—comes as about one-third of Americans, even those with insurance, report skipping meals or cutting back on other expenses to afford their medical bills.

The Times reported that at least one major health insurer—UnitedHealthcare, the nation's largest—is already equipped to start lending patients money to cover unexpected medical bills. The company operates a bank that administers loans to doctors and offers health savings accounts.

Rep. Shontel Brown (D-Ohio) said the latest proposal from the White House shows that President Donald Trump "is destroying healthcare from all sides."

The advocacy group Protect Our Care said the "suggestion" buried in the Centers for Medicare & Medicaid Services' final rule "is not only out of touch, it is cruel—accruing medical debt only adds to families’ financial burdens."

“While working families drown in the high cost of living, the Trump administration’s answer to the healthcare affordability crisis they created is to throw people an anchor made of medical debt and call it relief," said Leslie Dach, chair of Protect Our Care. "Trump and Republicans had a simple, popular fix sitting right in front of their faces—extending the ACA tax credits—but they killed it anyway, triggering premiums to double, triple, or even quadruple for millions of working families, all to make billionaires and big corporations even richer."

"Americans are being bankrupted by crushing medical debt, and this administration isn’t lifting a finger to help—it’s busy shoveling more people into that hole," said Dach. "Voters will remember this foolishness at the ballot box in November, just you wait.”

Melanie D'Arrigo, executive director of the Campaign for New York Health, which advocates for a universal, single-payer healthcare system for New York state, suggested the proposal makes the latest case for a federal, government-funded healthcare program similar to those in other wealthy countries, which would end the healthcare profit motive by expanding the existing Medicare system to the entire US population.

"Letting Americans take out loans to afford healthcare forces Americans deeper into debt and drives up profits for the health insurance industry," said D'Arrigo. "Abolish the health insurance industry. Demand Medicare for All."