Republicans’ repeal riddle

at 03:25 PM ET, 05/17/2012

Should the Supreme Court strike down Obamacare, Republicans may celebrate — but they may not throw the entire law out.


(JONATHAN ERNST - REUTERS)
As, Politico’s Jake Sherman and Jennifer Haberkorn report, “If the law is partially or fully overturned they’ll draw up bills to keep the popular, consumer-friendly portions in place — like allowing adult children to remain on parents’ health care plans until age 26, and forcing insurance companies to provide coverage for people with pre-existing conditions.” This follows on similar reporting from The New York Times last month.

The provisions that Republicans would keep are, Politico notes, the most popular parts of the health reform law. The difficulty is that they’re also the most expensive, and only become more so after repealing the mandate.

Health policy experts roundly agree that requiring insurers to cover pre-existing conditions, without mandating that everyone buy coverage, would drive up premiums. Without a mandate to purchase insurance, the thinking goes, only the sick people with high health care costs will buy coverage. In turn, premiums would increase.

Republicans are, in a way, caught between a rock and a hard place: They want to keep the popular parts of the law, but not the unpopular part — the individual mandate — that makes those well-liked provisions work. Without it, Avik Roy notes, the requirement for insurers to cover everyone falls apart.

“Forcing insurance companies to provide coverage to those with pre-existing conditions—what insurance wonks call “guaranteed issue” —would destroy the private insurance market, by creating an adverse selection death spiral in which people only buy insurance after they’ve already fallen ill,” he writes.

Researchers who have delved into the issue have estimated that premiums would increase anywhere from 2.4 to 40 percent. (The wide range reflects the different models and algorithms that economists use in their research.) But, in general, they all expect the same outcome: Fewer Americans would gain health insurance, and it would cost more.

For his part, House Speaker John Boehner has pushed back against the Politico report saying that the “anything short of full Obamacare repeal is unacceptable” and that Republicans intend to eliminate the law altogether.

 
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