For Republicans, Obamacare is not a pre-existing condition they can live with.
But if they stick to their pledges to keep covering would-be insurance enrollees who are already sick, and young adults clinging to their parents’ plan, whatever cure they adopt for the Affordable Care Act could hurt real bad.
President-elect Donald Trump and House Speaker Paul Ryan say those two provisions of the ACA will be retained in whatever replacement plan they come up with. Less clear is how they will cover the cost without the unpopular mandates that have required healthy individuals to buy insurance, or pay tax penalties for not doing so.
Insurance companies are imposing hefty premium increases, or have stopped selling policies, in states where they are not enrolling enough healthy residents to offset the costs of carrying the severely or chronically ill, whose care is a significant cost driver.
Washington has a history with regulations that required insurers to cover pre-existing conditions. They were a disaster.
The Health Services Act of 1993 allowed individuals to sign up for insurance after a three-month waiting period. The chronically ill enthusiastically jumped in. So did women in the early stages of pregnancy – but once they delivered their babies, some dropped out. As did others when illness passed.
The result: Premiums ballooned, as did insurance company losses. Insurers stopped selling policies to individuals. The crisis passed when the waiting period was extended to nine months, and other reforms were implemented.
Washington’s health insurance market healed.
Coverage of pre-existing conditions is among the ACA’s most popular provisions. Many of the 20 million-plus Americans who have health insurance thanks to the law could not get insurance before its enactment because they were already ill. If Republicans don’t want a repeat of Washington’s experience, where will the money come from? Or, where are the savings?
But Obamacare’s biggest shortcoming is the lack of cost control. Republicans have done their best to negate provisions that would address it.
Drug prices, for example, remain unconstrained. Early in his campaign, Trump talked about possible Medicare negotiation of prices, or allowing the re-importation of drugs. Neither step is likely in a GOP-controlled Congress.
There surely is a better plan than Obamacare out there. But Republicans free to criticize and repeatedly vote for repeal have gotten a free ride on detailing their alternative while President Obama has been in the White House. No more.
Health care in the United States is costly, inefficient and, worst of all, does not take care of patients as well as many other systems around the world. That’s the pre-existing condition the president-elect and speaker should be focused on.
Subscribe to the Morning Review newsletter
Get the day’s top headlines delivered to your inbox every morning by subscribing to our newsletter.