Jim McDermott, a Democrat, represented Washington in the House of Representatives from 1989 until his retirement this week.
As the new Congress begins its work this week, President-elect Donald Trump continues to call for repeal of the Affordable Care Act. However, rather than propose wholesale repeal — as many on the right would prefer — he is seeking to maintain some of the law’s most popular provisions.
We don’t have the full details of Trump’s plan — or any Republican health-care plan, for that matter — but we are starting to see its bones develop. There will be no individual mandate or similar mechanism to bring healthy Americans into the system, but Trump has indicated he wants to retain the requirement that insurers cover everyone, including patients with serious preexisting conditions.
Trump is telling Americans what he thinks they want to hear: that they can have all their dessert — consumer protections — without eating their vegetables — an individual mandate.
This might be an effective rhetorical technique, but it is not the truth. The reality is that such an approach would result in devastation to the health-care system.
This prediction isn’t based on speculation or unproven economic theory. Republicans already tried Trump’s approach in my home state of Washington. The result was a well-documented disaster.
In 1993, Washington designed a state-level health-care reform package that included consumer protections, such as a ban on medical underwriting and a requirement that insurers cover patients with preexisting conditions, paired with provisions to help balance the risk pool, including an individual mandate.
These provisions were intended to go hand in hand. Consumers would have guaranteed access to affordable coverage, while insurers would still have a sustainable business model because they would cover not just sick, but also healthy patients.
However, the fate of health-care reform took a sharp turn after Republicans won control of the state legislature in 1994.
They quickly unraveled the law by scrapping key provisions, including the individual mandate. But they kept in place many of the consumer protections, including the requirement that insurers sell policies to people with preexisting conditions.
It quickly became clear that this was unsustainable. Without an incentive to maintain coverage at all times, people could simply wait until they needed care to enroll in a policy.
The Seattle Times reported on one particularly expensive case of a woman who purchased a policy from Premera Blue Cross only after she became pregnant. After the insurer paid her medical bills, she had no further use for the coverage and canceled her policy.
She became pregnant again the next year and enrolled in a new policy. And, again, after her expenses were paid, she simply canceled.
This was not an unusual case. Insurers faced catastrophic losses as individuals enrolled in coverage only when they needed it. This wreaked havoc on the individual insurance market, causing dramatic premium spikes and an industry death spiral. By 1999 there were virtually no individual policies offered in the state.
We face a remarkably similar situation today. Trump and congressional Republicans plan to unravel the Affordable Care Act and disrupt the delicate balance between consumer protections and insurance market reforms. If they follow through on this, we know how the story will play out.
After years of denigrating the law and offering no reasonable alternative, Republicans are now in complete control of the federal government. The American people recognize that whatever happens over the next four years, Trump and his fellow Republicans will be responsible for the consequences.
Republicans would be wise to brush up on their history before they act.