In a desperate attempt to cling to their House and Senate majorities, Republicans everywhere are promising to protect Obamacare’s policy of forcing insurers to offer coverage to those with pre-existing conditions.
Whether it’s President Trump declaring pre-existing condition rules “safe,” Missouri Senate candidate Josh Hawley and Rep. Dana Rohrabacher citing their children’s health struggles in ads pledging to keep the rules, or a House resolution offered by endangered members, Republicans have been vowing support for one of the central pillars of Obamacare.
The broader context is that the ban on denying coverage to those with pre-existing conditions is one of the most popular aspects of Obamacare and Democrats have made the issue a key part of their campaign strategy in the midterm elections. Democrats have latched on to failed Republican repeal efforts and a pending lawsuit to charge that the GOP wants to eliminate protections for those with serious illnesses. Republicans, thus, have been eager to disabuse voters of this idea.
Whatever the short-term political rationale for such a move, however, it will inevitably box Republicans into an untenable position that will cripple any efforts to provide a meaningful healthcare alternative to voters.
Though there are a number of alternative ways to extend coverage to those with pre-existing conditions, by endorsing Obamacare’s approach, Republicans are making any sort of future free market reforms impossible. As conservative healthcare policy analyst Chris Jacobs put it during last year’s healthcare debate, “Republicans have a choice: They can either retain the ban on pre-existing condition discrimination...or they can fulfill their promise to repeal Obamacare.”
Making the concession on pre-existing conditions will inevitably put Republicans on the hook for defending other Obamacare provisions that are closely linked. For instance, once Republicans accept that insurers must offer coverage to all comers, it’s inevitable that they’ll have to embrace the community rating regulation that makes sure insurers cannot charge more based on health status. Otherwise, insurers could jack up premiums on those with serious illnesses, effectively putting insurance out of reach even if it’s technically offered. They’ll also have to embrace Obamacare’s “essential benefits” rules, or else insurers could discourage sicker individuals from buying their policies by picking and choosing what to cover. It also then becomes necessary to offer subsidies to ensure that those with less means can get coverage. Add it all up and you’re stuck with Obamacare.
Republicans have claimed repeatedly that their main goal is to lower costs and premiums, and yet the ban on pre-existing conditions, along with the associated regulations, are the main driver of higher premiums for younger and healthier individuals under Obamacare. Keep them in place, and any free market reforms, either at the federal or state level, would be stifled.
There are, of course, other ways to navigate this issue. Republicans could pledge to support significant federal funding to high-risk pools or other state-based endeavors to get coverage to those with pre-existing conditions. The point would be, if as a society there is agreement that there should be coverage to those who would have difficulty finding coverage in a pure free market, it’s better to have those costs spread among hundreds of millions of taxpayers than have them concentrated among a few million individuals in the form of drastically higher premiums.
Instead of making the sort of arguments that would lay the groundwork for free market reforms, Republicans are resorting to the same incoherence that got them into this mess in the first place. During the Obama era, Republicans latched on to whatever was in the daily headlines to score short-term messaging victories while failing to make any sort of broader case for a free market alternative. They were too lazy to use the time productively to hash out differences among themselves. This made inevitable that once they came into power, they would be completely unprepared to deliver on their “repeal and replace” pledge. Now, they are once again choosing expediency over a broader healthcare strategy.
This is not the only healthcare issue on which we can see this. Republicans have also taken to responding to the threat of socialized medicine by arguing that “Medicare for all” would threaten traditional Medicare. This is of course absurd, given that the traditional Medicare system they’re praising is an example of socialized healthcare. Beyond that, perpetuating the idea that Medicare is untouchable undercuts any proposals to overhaul the entitlement program, which just a few years ago, was a central part of the GOP agenda.
Don't look to the GOP for a rational and coherent alternative to expansive government, because Republicans offer nothing more than a healthcare strategy designed by idiots, full of sound and fury, achieving nothing.