AJC editors and columnists just finished a pretty wide-ranging 80-minute interview with Sen. Saxby Chambliss and Senate Minority Leader Mitch McConnell, and I took the opportunity to ask a question that had been nagging at me for a while.
Both men stressed that on health care, “repeal and replace” would remain the GOP message into the fall elections. However, both also acknowledged that they would like to retain some aspects of the Democrats’ plan, such as coverage of pre-existing conditions.
I’ve seen that goal expressed repeatedly by Republicans, but I’ve never seen an explanation of how they would accomplish it. Hated as it is, the “pre-existing condition” exclusion often serves a legitimate purpose. Insurance companies use it to discourage “free riders” who would otherwise choose to go without coverage for years, buying a policy only when they come down with a serious illness or injury.
If you somehow tell companies they can no longer deny coverage of pre-existing conditions, you need to provide them another way to eliminate free riders. Under the new law, individual mandates are that tool. As long as everyone is required to have coverage, nobody can game the system and there’s no longer any justification to deny coverage based on pre-existing conditions.
So if the GOP plan is going to ensure that pre-existing conditions are covered, as Chambliss and McConnell suggested, how would they do it without individual mandates? What mechanism would they use?
Chambliss and McConnell had no answer. Literally.
After Chambliss fumbled an initial response, McConnell broke in with a long and familiar condemnation of the Democratic plan, including its failure to include tort reform. After a few minutes, I interrupted and brought him back to the question: OK, but how are the Republicans going to cover pre-existing conditions?
“The premiums are going up either way,” he said.
OK, I responded, a little stunned. That doesn’t explain how the Republicans intend to cover pre-existing conditions.
“The premiums are going up either way,” he repeated.
That was that. We moved on, and I still don’t have my answer.
Actually, I guess I do. Republicans clearly understand that the American people want the problem of pre-existing conditions to be solved; it’s also pretty clear that they have no idea how to achieve that goal. In fact, while they campaign on “repeal and replace,” they intend to keep that whole “replace” thing as vague and ill-defined as possible. In response to another question, McConnell said explicitly that the Republicans would not be drafting a specific plan on how they intend to replace ObamaCare. Instead, he said, individual GOP candidates would each be offering their own ideas of what a good replacement might look like.
Those ideas will no doubt include pledges to address pre-existing conditions, even if they don’t have the vaguest idea how.