But Republicans also say that they support some parts of the health care law — like the consumer protections that would prohibit insurers from denying coverage to individuals with pre-existing conditions. Those elements would help consumers but they’d be better off if Obamacare were repealed and replaced with similar provisions. As Sen. Richard Burr (R-NC) explained during his debate in North Carolina last night, “Those provisions are acceptable to me and most Republicans and most Americans,” he said. “I think it’s important to realize we could have the elimination of pre-existing conditions tomorrow. We could have the elimination of lifetime caps tomorrow. We could begin to close the doughnut hole tomorrow. But you can’t fix the current health care bill that the president passed.”
So would Republicans really adopt strong consumer protections? It’s unlikely. The House Republicans’ ‘Pledge,’ for instance, guarantees coverage regardless of pre-existing condition only to those beneficiaries who had been previously insured. The uninsured can still be denied coverage. Similarly, a bill offered by Sens. Burr and Tom Coburn (R-OK) in May of 2009 encouraged states to “establish rational and reasonable consumer protections,” but did not eliminate the practice of denying coverage nationwide. Throw into this mix yesterday’s comments by Sen. John Cornyn (R-TX) and you quickly get the sense that any GOP pre-existing condition provision would be limited at best:
SIEGEL: But the basic change here, the government has expanded the entitlement to health insurance. Do you hope to see that expansion undone as a matter of federal law?
CORNYN: I think the way it was done is problematic because it imposes a fine on individuals who don’t carry health insurance, but it says, on the other hand, that if you get sick, that an insurance company must issue you a policy regardless of your preexisting conditions and the like, which is driving up the cost of insurance. I think the model, to me, the ideal model is one that we’ve seen used in companies like Whole Foods Company in Austin, Texas, using health savings accounts.
Cornyn, of course, has it backwards. You can’t require insurance companies to “issue you a policy regardless of your preexisting conditions” unless you impose “a fine on individuals who don’t carry health insurance.” If you don’t find a way to encourage people who otherwise wouldn’t have bothered with health insurance to buy coverage, you can’t eliminate the pre-existing condition denials. That’s because without a mandate that brings healthy people into the program, the provision requires insurers to accept individuals who waited too long to purchase coverage. These sicker applicants would use up a lot of health care and drive up costs for everyone else in the pool, pushing out younger and healthier applicants (and their premium dollars). Only sick people who desperately need coverage would remain in the plan and as Kentucky, Main, New Hampshire, New Jersey and many other states have all found out, that’s a prescription for failure.
So the larger point here is that no matter what Republicans tell you about pre-existing conditions, without a mandate, they can’t possibly replace the existing consumer protections. All they can offer is some inferior provision that look a lot like the existing HIPAA law and won’t do much for the uninsured.