The National Journal’s Margot Sanger-Katz and Meghan McCarthy have an interesting piece examining how the GOP presidential candidates obtain health insurance coverage, given their support for repealing the Affordable Care Act and pushing individuals and families into the individual market:
— MITT ROMNEY: The Romney campaign refused to say where he gets his health care coverage. But because of the health care reform law he signed as governor of Massachusetts, he is lucky to live in one of the few states with good insurance options for a 64-year-old unemployed man with a wife who has a preexisting health condition: multiple sclerosis.
— RICK SANTORUM: The 53-year-old former senator from Pennsylvania is enrolled in insurance that “is totally private, and not related to his time in Congress,” his spokesman, John Brabender, said in a phone interview. And if Republicans succeed in their stated goal of repealing “Obamacare,” Santorum likely won’t be firing his insurer any time soon, since his daughter suffers from a pre-existing condition.
— NEWT GINGRICH: Gingrich, 68, is enrolled in Medicare and buys his own supplemental insurance from Blue Cross Blue Shield, according to his campaign.
— RON PAUL: Paul, 76, as a member of Congress, gets his insurance coverage from the federal-employee benefit program, his campaign says.
— RICK PERRY: Perry, 61, gets his insurance from the state of Texas, a benefit he can continue to receive for the rest of his life. (According to the Texas Tribune, Perry is already collecting a state pension, even while he earns his salary as governor.)
These men are insured in large-group policies that don’t discriminate against pre-existing conditions and spread the risks and costs of insurance among a pool of healthy and sick applicants who can use the advantages of their size to negotiate better rates with medical providers. (It’s unclear if Santorum actually has an individual policy or a group plan through his campaign or think tank affiliation.)
Their campaign proposals, however, would encourage individual Americans to face down health insurance companies on their own and seek out affordable rates in an unregulated national market where companies can sell policies that don’t comply with state consumer protections and offer little reliability. Insurers have an incentive to enroll the healthiest beneficiaries and avoid or price out older applicants, so that the GOP candidates and many millions of Americans who suffer from pre-existing conditions, would have a hard time finding affordable insurance if they don’t have an alternative offer of employer coverage. In that case, they could (under the Republican proposals) end up uninsured or in a state-based high-risk insurance pool, where the enrollees’ older and sicker risk profile leads to higher premiums and out-of-pocket spending. Those are costs that this particular set of wealthy candidates could surely afford, but many other Americans will struggle with.