Earlier this month, I wrote about how when Republicans talk about the “need to govern,” they normally mean the “need to govern like liberals.” Last week, a group of ten Senate Republicans perfectly illustrated that axiom.
The Republicans, led by Sen. Thom Tillis (R-NC), introduced “legislation to protect Americans with pre-existing conditions.” Their bill would codify as part of the Health Insurance Portability and Accountability Act (HIPAA) requirements that insurers accept all applicants, regardless of health, and do not vary premiums based upon health conditions.
Those provisions already exist in law. Congress enacted them in 2010 as part of Obamacare. However, a pending lawsuit could result in federal courts striking down all of the 2010 law. (While I support Congress repealing Obamacare, I have previously outlined my disagreement with the legal reasoning behind the suit.)
Democrats have used the pending lawsuit to mount political attacks on pre-existing conditions. For instance, last week Sen. Joe Manchin (D-WV) attempted to offer an amendment directing the Senate’s legal counsel to intervene in the lawsuit to defend Obamacare, which some Republicans viewed as a politically difficult vote. Hence Tillis’ bill, which gave the ten Senate Republicans political cover to oppose Manchin’s amendment while still claiming to protect pre-existing conditions.
Although likely a messaging exercise, the Tillis bill sends at least four messages to voters about Republican views on health policy—none of them positive.
Senators Don’t Want to Repeal Obamacare
Last spring, I wrote that Republicans had a choice: They could either retain Obamacare’s pre-existing condition provisions, or they could fulfill their promise to repeal the law. They keep trying to do both, but as a policy matter, they cannot.
Obamacare’s pre-existing condition regulations lie at the heart of the sprawling, 2,700-page law. They serve as the prime driver of premium increases, according to a Heritage Foundation study released in March.
The premium increases caused by those regulations necessitated requirements to purchase coverage, and for businesses to offer coverage, to try and keep healthy people purchasing (more costly) insurance. They necessitated Obamacare’s insurance subsidies—to make coverage “affordable.” And the premium increases caused by the regulations required Obamacare’s taxes and Medicare reductions to finance those federal subsidies.
The pre-existing condition provisions stand as the foundation stone of Obamacare. Conservatives who want a true alternative to the law have other policy options for people with pre-existing conditions than merely retaining Obamacare’s federal regulations. But if Republican senators want to codify that provision elsewhere, then, as a practical matter, they want to retain the law.
Republicans Once Again Oppose Federalism
Among others, Sen. Lindsey Graham (R-SC) sponsored Tillis’ legislation. Last year, of course, Graham stood as one of the prime co-sponsors of the Graham-Cassidy bill, which sought to devolve most of Obamacare’s health spending to the states via a block grant. Graham’s website retains press releases talking about how he supports a “state-centric” system that would “return power” outside of Washington.
The bill he sponsored with Tillis would do none of those things. In fact, it stands diametrically opposed to the principles Graham outlined. It would retain Obamacare’s costliest insurance requirements at the federal level, such that if states did receive a block grant, they would have to manage their own insurance markets without Washington giving them sufficient authority to do so, likely resulting in a policy mess.
The sharp contrast between Graham’s rhetoric on state-centered solutions, and his actions supporting a Washington-centered health-care system, show that he and his colleagues either do not understand the principles of federalism, or they discard those principles when they find them politically inconvenient.
Effectively Taxes the American People
Multiple analyses have discussed how Obamacare’s high deductibles make coverage feel meaningless to exchange enrollees. As an example, this year I will pay nearly $3,500 for a Bronze Obamacare policy with a $6,200 deductible—a deductible I have little chance of meeting unless I get run over by the proverbial bus, or suffer some other catastrophic incident.
I do have some pre-existing conditions, including mild asthma and a foot condition that required reconstructive surgery some years ago. Between these and the general randomness of life, the risk of a major medical condition that causing me to exceed my deductible remains greater than zero. But I doubt it warrants a $3,500 premium either.
Instead, a significant portion of my $3,500 in premiums this year is designed to fund someone else’s medical condition. That difference between an actuarially fair premium and the $3,500 premium my insurer charged me amounts to a “pre-existing conditions tax.” That tax forcibly redistributes money from the healthy to the sick via government regulations—and, in the case of the nation’s capital, a requirement to purchase insurance.
Lawmakers don’t like talking about this “tax.” Wouldn’t you know it, few liberal organizations have attempted to quantify how much of a “tax” the average healthy person pays in state exchanges, although they’re quick to quantify the individuals with pre-existing conditions “at risk.” But this forcible redistribution of wealth exists nonetheless, and the Republican lawmakers just endorsed it.
Liberals Always Find Republican Concessions Insufficient
Hours after Tillis introduced his bill, liberal analysts already had outlined reasons to call it insufficient. According to them, the Tillis legislation would prohibit insurers from rejecting applications from people with pre-existing conditions outright, but they could still impose exclusions on specific conditions:
A new bill would require insurers to guarantee access for people with pre-existing conditions and prohibit premiums based on health. But, it would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch.https://t.co/Dgc1DNor0B
— Larry Levitt (@larry_levitt) August 24, 2018
Therein lies Republicans’ problem: The more they concede, the more the Left demands. When the next wave of greater government control of health care comes along, don’t say I didn’t warn you—and don’t say that Republicans acted to protect you, either.
An earlier version of this article incorrectly stated the figure of the author’s deductible, by a difference of $400.