WHO SAYS Americans are hopelessly divided over political issues? On one vital subject, the 2018 campaign has revealed a consensus that is both broad and deep: The people want government to require that health insurers cover everyone regardless of preexisting medical conditions. Period.
We know this, because in races up and down the ballot, all across the country, Republican candidates are cutting direct-to-camera ads denying Democratic charges that the GOP would eliminate Obamacare’s provision making it unlawful for insurance companies to deny coverage to those with a history of cancer or chronic illnesses such as diabetes, or charge them more for it. These candidates fear overwhelming public opinion as reflected in polls such a September Morning Consult survey showing that 81 percent of registered voters, including essentially equal portions of Republicans and Democrats, back coverage for those with preexisting conditions. The upshot is that the majority of representatives, senators, governors and state legislators who win office this year will be on record as embracing a key tenet of Obamacare.
And the logical, if implicit, consequence of this is that they are on record as supporting universal coverage, too. Why? Because once you ban private insurance companies from using “adverse risk selection” — the denial of coverage to those already ill or at higher risk of becoming ill — simple economics requires that they share those elevated risks among the widest possible pool. And it doesn’t get any wider than “everyone.”
Republicans set this trap for themselves by trying to repeal Obamacare in its entirety last year and, when that failed, greatly weakening the individual mandate by zeroing out the tax penalty — thus endangering insurers in the individual market. To make matters worse, Republican attorneys general from 20 states, led by Texas, have asked a federal court to declare Obamacare unconstitutional, on a legal theory that practically defines chutzpah: The law is no longer viable without the individual mandate.
The simple truth is that, for all its flaws, Obamacare presented a plausible means of achieving the “guaranteed issue” of insurance the public clearly wants, without bankrupting the private health-care industry in the process: an individual mandate, enforced with a tax penalty and facilitated by an offer of subsidized premiums to lower-income people. Among the GOP candidates who backed the lawsuit now facing the cameras and protesting their determination to protect those with preexisting conditions are Wisconsin Gov. Scott Walker, who is running for reelection, and Missouri Attorney General Josh Hawley, who is running for Senate against incumbent Democrat Claire McCaskill. They and others argue that there are alternatives to Obamacare for protecting people with preexisting conditions. Undoubtedly there are, though we have yet to see a specific Republican plan. But no such alternative would be workable without mechanisms for maximizing enrollment and for restraining costs.
It’s the height of free-lunch irresponsibility for Republicans to suggest that consumers could have mandatory coverage for preexisting conditions otherwise. It was already the height of hypocrisy for them to render Obamacare’s individual market less stable — then pledge to keep the part of it everyone likes. As the saying goes, though, hypocrisy is the compliment vice pays to virtue.