There’s a reason Trump and Congressional Republicans haven’t come up with a healthcare plan which protects pre-existing conditions, after promising dozens of times over the past decade that one is just around the corner.
It’s because America already has a conservative, Republican-originated health care plan which protects pre-existing conditions: It’s called The Affordable Care Act (a/k/a Obamacare).
For reasons detailed below, there is no economically feasible way to protect pre-existing conditions other than through either the ACA or Medicare-For-All.
First a little history: Looking back to the early days of Obama’s presidency in 2008, there were two broad policy frameworks for substantially increasing Americans’ healthcare coverage.
The first was Medicare-For-All which would effectively expand Medicare to all Americans, be funded by taxes instead of premiums to profit-making insurance companies, and guarantee healthcare for all. This had been the Democratic Party’s goal for decades, going back to FDR and The New Deal.
The second was a market-based alternative devised by the conservative Heritage Foundation which Mitt Romney, when he was Governor of Massachusetts, adopted, with Heritage Foundation assistance. It was passed into law in Massachusetts in 2006 and came to br called “Romneycare”.
President Barack Obama readily admits that Obamacare was modeled, in large part, on Romneycare.. As President Obama himself writes, “I was convinced…that Romney’s model offered us the best chance of achieving universal coverage.” And as extreme right-wing columnist Ann Coulter explained, “A leading conservative think tank, The Heritage Foundation, helped design Romneycare and its health care analyst Bob Moffit flew to Boston for the bill signing.”
Romney and the Republican Party have since disavowed Romneycare and claimed it has little relationship to Obamacare.
But as a Daily Beast article entitled “Romneycare and Obamacare Differ in Inconsequential Ways“ explains, “there are no fundamental differences between the two laws. Both programs create exchanges where private insurers compete. Both require individuals to purchase insurance. And both subsidize those who can’t afford it…Massachusetts was the first place it was adopted, and the Affordable Care Act was the second. The two laws are, in the words of Jonathan Gruber, who helped design both the Romney and Obama plans, ‘the same fucking bill.’”
Medicare For All addresses this problem by an "everyone in, nobody out" approach. From birth to death, every American is guaranteed health care, paid for by taxes instead of premiums to private insurers.
The Republican Party has moved even farther to the right since 20 years ago. Back then, conservative Republicans still thought they needed at least the pretense of “free market” alternatives to Democratic plans to help Americans with the likes of healthcare and retirement benefits. Romneycare was a striking example of this prior Republican approach. By 2020, most Republicans no longer see the need for this pretense and care only about packing the courts with extreme right-wingers, cutting taxes for the wealthy and corporations, cancelling environmental regulations, opposing abortion rights, and pandering to white supremacists.
Republicans have tried about 60 times to repeal Obamacare in Congress. A second Republican lawsuit to have it overruled as unconstitutional will be heard by The Supreme Court a week after the 2020 election, with Amy Coney Barrett joining the conservative majority already on the Court.
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For ten years, Republicans have been promising that any day now they will propose their own health care plan to replace Obamacare and still protect pre-existing conditions. They have still come up with nada. The reason is that something like Obamacare or something like Medicare for All are the only possible ways to protect pre-existing conditions.
The basic business model of private insurance companies is to collect more money in premiums than they pay out in benefits (plus multi-million dollar bonuses to their executives and multi-billion dollar dividends to their shareholders.) But if there’s a law prohibiting private insurers from turning away people with pre-existing conditions, and that law doesn’t also include provisions guaranteeing the insurers a large enough pool of both healthy and less healthy customers to cover costs, their business model just doesn’t work.
Young healthy people, most of whom need little heath care, can wait until they get sick before they sign up and pay premium. Older and/or sicker people—let’s say people diagnosed with cancer--can sign up right away and start getting care, the cost of which will far exceed their premium payments. To cover these costs, private insurers will either have to raise premiums to a point where they’re unaffordable, stop offering health insurance altogether, or risk bankruptcy.
Medicare For All addresses this problem by an “everyone in, nobody out” approach. From birth to death, every American is guaranteed health care, paid for by taxes instead of premiums to private insurers. The covered pool is every American, so covering people with pre-existing conditions and people who are healthy and need little care is affordable. (By cutting out humongous executive salaries and private profits, and giving an entity as large as the Federal government the ability to negotiate prices, per capita health care costs would become more affordable.)
Obamacare/Romneycare addresses this problem differently, by creating exchanges where people can buy health insurance and by subsidizing lower and middle income people’s premiums. So far, this has created a big enough pool of both healthy and less healthy people to keep insurance premiums relatively affordable, after the subsidies. (To incentivize people to buy insurance, Obamacare includes a mandate requiring everyone to have insurance and originally included a tax on anyone who failed to obtain it. Republicans zeroed out the amount of the tax, which is the basis for their Supreme Court case to overturn Obamacare.)
In sum, there is simply no way to protect people with pre-existing conditions, other than an Obamacare/Romneycare approach of subsidized insurance exchanges, or a Medicare For All, everyone in, nobody out approach. That’s why it’s been impossible for Republicans to propose their own alternative plan to protect pre-existing conditions. It’s tougher than landing a man on Mars.
Republicans should worry if the Supreme Court takes their side and overturns Obamacare in its entirety. Tens of millions of Americans with pre-existing conditions will lose their health insurance (amplified further by a positive Covid test constituting a pre-existing condition.) If that happens, the political backlash against Republicans will be unfathomable.
If Biden wins the Presidency and the Democrats control a majority in both houses of Congress, they will then have two choices. They could try to rewrite and pass a new version of Obamacare that cures the alleged Constitutional defects found by the Supreme Court. Or they could go all the way to Medicare For All and join the rest of the developed capitalist world in offering truly universal health care to all Americans at a per capita cost nearly half of what America now pays. Why go to the time and effort to reconstruct a form of Obamacare that still doesn’t cover millions of Americans and may well become too expensive in coming years?
Think about it, John Roberts and Amy Coney Barrett: If you successfully vote to overturn Obamacare in its entirety, do you want to go down in history as the people who ushered in the era of Medicare For All?