Smart Bombs: Heed side effects of repeal

Now that Dr. House has vanished from his TV practice, it would be nice if he could turn his attention to this puzzler: What would Republicans do if the U.S. Supreme Court makes their day by dumping health care reform? A man of House’s skill for negotiating red herrings and emotional traps would be perfect for this case. Plus, his mantra – “everybody lies” – would serve him well.

If you think this is an easy case to crack, follow me to the white board.

On Tuesday, it looked as if Mitt Romney had unveiled a fresh plan for health care reform. But a re-reading of his USA Today column on the subject last year shows there was nothing new in this news. In the op-ed from May 2011, Romney wrote: “If I am elected president, I will issue on my first day in office an executive order paving the way for waivers from Obamacare for all 50 states. Subsequently, I will call on Congress to fully repeal Obamacare.”

On Tuesday, he said, “I will repeal it on Day One by sending out a waiver to all 50 states.”

Since he wants states to solve this issue, wouldn’t it be best to wait for them to request an exemption? Washington state wouldn’t want one if Jay Inslee is elected governor. It’s doubtful GOP candidate Rob McKenna would want one either, because he’s said the chief reason for his legal challenge was the mandate to purchase insurance. He’s seemingly fine with the other provisions, and he doesn’t believe the Supreme Court needs to dump the law in its entirety. So if McKenna lost on the mandate, he would lose any rationale for a waiver.

It’s doubtful Massachusetts would want an exemption, since Romney, as governor, signed a law that’s strikingly similar to Obamacare, including a mandate to buy insurance. A waiver would merely send federal dollars elsewhere.

In fact, it’s not clear how many states would seek the waiver because so many households have liked adding young adults to their health plans, and most legislatures have begun establishing the insurance exchanges the law calls for. In Olympia, the Senate voted last year to align state law with the Affordable Care Act by a 45-4 vote. Republican leadership supported the bill.

By far, the most coveted provision of the Affordable Care Act is the one that unconditionally precludes insurance companies from denying coverage for pre-existing health conditions. Romney does not support this, though it might seem otherwise. Last week, the Associated Press reported that he “promised to help maintain coverage for those with pre-existing conditions.” The key word is “maintain.”

As Romney has pointed out, you could be turned down if you lost your job and your coverage lapsed for a couple of months, or if you’re buying your first policy. So, he is merely restating federal law since 1996, which prohibits dropping customers who have had continuous coverage. So it’s not clear what he would do after repealing reform, especially since he wants to turn this over to the states and “market-based” solutions.

Actually, he wants the façade of state control and free markets, because he’s also advocated allowing people to buy insurance across state lines, which serves to gut state guidelines on what constitutes a basic health care plan. This merely shifts the market to the states most willing to eviscerate their standards. For instance, an insurance plan could drop prenatal care and drop the price of premiums. Let’s say Arkansas decided to become the Wal-Mart of health plans by allowing skimpy policies. In turn, this produced the “best” prices. If shoppers flocked to the Arkansas insurance market, the mandates of other legislatures would be circumvented. So much for state control.

Upon completion of this race to the bottom, the nation would be left with a growing population of people who are underinsured, along with those who refuse to buy coverage. The rest of us would then watch our rates climb to cover their care. How do we know this? Because it happens now. This subsidy costs the typical Washington state family nearly $1,000 a year in higher premiums, according to Insurance Commissioner Mike Kreidler. Charity care and bad debts cost providers nearly $1 billion a year.

A market-based solution? Or a redistribution of the wealth in disguise?

Dr. House has the answer, but it won’t save the patient.