Republicans voted to repeal the Affordable Care Act more than three dozen times, ran on a pledge to eliminate the law on “day one,” and sought to underfund the measure at every opportunity. But since the Supreme Court upheld the ACA and President Obama won re-election the political dynamics of reform have changed: Republican governors are slowly embracing elements of the law and Congressional Republicans are no longer scheduling votes to repeal it.
In another sign of the growing political support for health reform — or the sense that opposing its most popular elements has become politically perilous — a group of top House Republicans have written a letter to President Obama asking him to preserve a temporary program included in the law that provides health care coverage to people with pre-existing conditions.
The so-called Pre-Existing Condition Insurance Plan (PCIP) was designed as a bridge to the exchanges for families and individuals who don’t have an offer of coverage from an employer and cannot find insurance in the individual market. The $5 billion program, which covers only sick people is incredibly costly, and will soon stop processing new applicants.
Republicans however, are incensed, and are demanding that the White House shift funds from prevention or comparative effectiveness research to keep the PCIP running.
“Your administration’s action will leave thousands of Americans with pre-existing conditions without access to health care,” the group of House Republicans write in a letter first obtained by the Talking Points Memo’s Sahil Kapur. The letter reiterates the GOP’s opposition to the Affordable Care Act as a whole but notes, “to allow PCIP to continue to accept new enrollees, we urge you to support efforts to transfer the funds necessary from other PPACA programs, such as the Prevention and Public Health Fund, the Secretary’s transfer authority to assist with state based exchanges, comparative effectiveness, planning, or another similar program to PCIP.”
The idea behind the PCIP had been advanced by the GOP during Sen. John McCain’s (R-AZ) presidential bid in 2008, though Republicans had questioned its effectiveness when it was included in the ACA. The PCIP’s relatively low enrollment rates and the government’s inability to maintain the program through 2013, however, is also an indictment of the failure of health policy proposals that seek to further fragment the health system between the sick and the healthy. Sick people are very expensive to insure — they spend all the premiums they contribute and then some. Without a mechanism that encourages younger and healthier individuals to buy coverage and spread the risk and cost of insurance, programs composed of very costly applicants are not sustainable. And that’s a strong rebuke to Republican proposals that would deregulate insurers and allow them to market policies exclusively to healthy people, while enrolling sicker Americans into government-funded high risk pools.
The letter to Obama was signed by House Speaker John Boehner (R-OH), House Majority Leader Eric Cantor (R-VA), House Majority Whip Kevin McCarthy (R-CA), Republican Conference Chair Cathy McMorris Rodgers (R-WA), Energy & Commerce Chair Fred Upton (R-MI), Energy & Commerce Health Subcommittee Chair Joe Pitts (R-PA) and Rep. Michael Burgess (R-TX).