Pre-existing Ignorance

Published September 10, 2012

National Review Online

I’m frankly a little puzzled by the kerfuffle over Mitt Romney’s statement Sunday morning that his version of health reform would also make sure people with pre-existing conditions had access to coverage. Lots of political reporters and analysts have taken this to be some kind of new position, or a concession, or a backing away from the commitment to repeal and replace Obamacare.

But this is what Romney has said since his first remarks on health care in this campaign, and what basically every conservative who has had much to say about health-care reform has said since well before Obamacare. For as long as Romney has had a campaign web site with a section on health care, for instance, it has listed among the elements of his proposal to replace Obamacare “Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage.” And Romney has talked about this point himself before too, as Katrina notes below. His reference in all these instances to protecting people who are continuously insured also tells us that he’s not talking about a system that would involve an individual mandate to work, but rather one that would use the protection of those with continuous insurance (combined with reforms of the tax code and other steps to make it possible for people to remain continuously insured) as a powerful incentive for the young and healthy to obtain insurance.

This kind of mechanism, using high-risk pools combined with prohibitions on pre-existing condition exclusions for the continuously insured, has been part of just about every conservative health-care proposal in recent years, including John McCain’s in 2008, the Ryan-Coburn alternative to Obamacare, and the congressional Republicans’ “Pledge to America” before the 2010 elections (as well as older proposals in the Bush years). The basic structure of these different proposals is very similar, and is based on many years of conservative policy proposals along these lines—here’s a great detailed overview of how this would work.

Mitt Romney hasn’t offered much detail about his version, but what he said today was no more or less than what he has said before and it suggests exactly this approach. The fact that this was treated as earth-shattering news suggests first of all that many political reporters just haven’t bothered to look at what proposals Romney has offered, and second (not surprisingly) that they’ve fallen for the Democratic line about Obamacare.

That line involves, first of all, the notion that Obamacare is simply the definition of health-care reform, and that to oppose it means to not want to solve the problems with our system. Reporters are therefore surprised anytime a Republican expresses the desire to solve those problems, and they assume that means he must want to keep Obamacare. They have no idea, for instance, that numerous Republicans in recent years have backed proposals (like this one) that would be likely to get us much closer to universal coverage than Obamacare (which after all CBO says will leave 30 million people uninsured) at far lower cost.

And this line involves, secondly, the notion that the little things Obamacare has started to do (including constraining the exclusion of pre-existing conditions by insurance companies) are the essence of Obamacare, so that to oppose Obamacare is just to oppose these.

The fact is that all of the rules and requirements that have gone into effect before Obamacare really gets going in 2014 are just little bones thrown to the public to distract voters from what Obamacare is all about. The pre-existing condition question, which is so prominent in the rhetoric of Obamacare’s champions, is a perfect example of this. Pre-existing condition exclusions have been illegal in the employer-based insurance market (where the vast majority of privately insured people get their coverage) since the mid-1990s, so they only affect people who are in the individual market or who have gone without insurance for a time. Even in those situations, such exclusions are prohibited in many instances, and are not practiced by insurers in most others, though not all. About 2 to 4 million people are estimated to be vulnerable to such exclusions (though not all of them are in circumstances that mean they actually experience them). That’s roughly 1% of the population. That doesn’t mean their problem is unimportant (or that other people shouldn’t be worried about finding themselves in that group in the future), but rather it means that it can be solved without spending $2 trillion, raising taxes by nearly a trillion, taking $716 billion out of Medicare to fund a new unsustainable entitlement, imposing layers upon layers of new bureaucracies and regulations between people and their medical care, causing millions of families to lose the coverage they have now, and undermining employment, investment, and medical research. The idea that Obamacare is about dealing with pre-existing condition exclusions or keeping 26-year-olds on their parents’ insurance is just plain nonsense.

Obamacare is a disaster for American health care. It doubles down on essentially everything that is wrong with our badly broken system of health-care financing and adds new problems to boot. There are far better solutions out there. It would certainly be nice if Mitt Romney made his support for such alternatives more explicit and specific, but what he has offered would definitely be a huge improvement. He should help clueless reporters find out more about it—or at least make it harder for them to pretend his proposals don’t exist.

Yuval Levin is Hertog fellow at the Ethics and Public Policy Center and editor of National Affairs.

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