One thing you’re hearing Republicans grapple with as they face the prospect of the Supreme Court overturning the entire health care law is that they want to keep the more popular provisions intact. Invariably that includes excluding insurance companies from discriminating against potential customers on the basis of a pre-existing condition, perhaps the most popular part of the entire Affordable Care Act. Even if the Supremes uphold most of the law, if they throw out the individual mandate, the Obama Administration has asked them to also toss the pre-existing condition exclusion, on the grounds that it would be “unworkable” (several experts beg to differ). So this is a key question.
Mitt Romney, in his latest health care plan, has decided to allow that discrimination to continue.
In a speech in Orlando on Tuesday, presumptive GOP presidential nominee Mitt Romney outlined once again what he would do to replace President Barack Obama’s health care law, which he has pledged to throw out if elected. In a follow-up statement to The Huffington Post, his campaign clarified that he would not tackle one of the central issues contained in the Affordable Care Act — the prohibition of discrimination against people with pre-existing conditions.
The approach Romney described centers around proposals to return much of the decision-making to the states while allowing for greater portability of coverage. He has long disavowed federalizing the individual mandate that he passed while governor of Massachusetts, which requires the uninsured to purchase coverage or face a penalty. And so attention has turned to the most closely related provision, a ban on discriminating against individuals with pre-existing conditions.
In his Tuesday speech, Romney said that under his plan, a person who is covered by his or her employer and has a pre-existing condition could not get dropped after switching jobs. The Obama campaign’s policy director, James Kvaal, argued in response that such a concept was already law. Under the Health Insurance Portability and Accountability Act of 1996, a person can’t be excluded from health insurance coverage because of a pre-existing condition provided that he or she has had continuous coverage.
So the pre-existing condition exclusion, as it does now, covers a sliver of the marketplace, those without coverage at work in the individual market. And Romney would make it nearly impossible for those who have pre-existing conditions in that position to get insurance. The only lifeline he offers would be high risk pools, a Republican feature of the Affordable Care Act that simply hasn’t worked. They were always seen as a stopgap reform, and the takeup rates have been abysmal. Romney’s spokeswoman says he would allow risk adjustment and reinsurance on the high risk pools to save money, but the way to ensure that anyone with a pre-existing condition can get coverage through a high-risk pool is to budget for it, and there’s really no way you could deliver the kind of money needed for that to happen. You just can’t segregate a community of the sick into an insurance pool and expect that pool to provide cheap insurance. The system doesn’t work that way.
Added to this is the fact that Romney would block grant Medicaid, which would significantly cut the program, putting more low-income individuals either without health insurance or into the individual market. Given the relationship between income and health status, that means, if anything, more sick people in need of insurance while carrying a pre-existing condition. Finally, any barriers to discrimination at the state level could be easily surmounted by Romney’s vow to allow consumers to “buy health care across state lines.” This will simply lead to every health insurer moving to states with little or no insurance regulations, sidestepping regulations in the more stringent states.
Romney’s health care plan isn’t really a plan in that it has precious few numbers. But what we do know of it suggests that it would look mostly like today, only worse for anyone who has an illness and not much money to afford care.
These are the warmed-over Republican ideas for health care. We actually know what works in the health care system, but neither side has allowed that policy to come to America.