Healthcare for all, somehow

As House Republicans prepared for a symbolic vote to repeal the comprehensive healthcare reform law enacted last year, the Obama administration sought to remind lawmakers about one of the thorny problems the law aims to solve. A report issued by the Department of Health and Human Services estimates that up to 50% of Americans below retirement age have preexisting health conditions that have led insurers to raise their rates or deny them coverage.

The department concluded that “between 50 and 129 million nonelderly Americans have at least one preexisting condition that would threaten their access to healthcare and health insurance” without the protections of the new law. Many of those people obtain insurance through large group policies at work, where preexisting conditions aren’t a barrier to being insured — as long as they keep their jobs. But those in small groups or who buy insurance individually have no such protection.

The healthcare reform law addresses the problem through three interrelated provisions that take effect in 2014. It creates new state insurance marketplaces (“exchanges”) that gather individual insurance customers into a big group, spreading their risks across a broad pool. It bars insurers from denying coverage to or levying higher premiums on people with preexisting conditions. And because that last rule might encourage people to obtain coverage only when they get sick and need expensive treatment, it requires all American adults to carry insurance.

The controversial mandate to buy insurance is one of the main reasons House Republicans will vote to repeal the healthcare law, even though there’s no chance the Democratic-controlled Senate will follow suit or that President Obama will agree. It’s worth exploring other ways to make the reforms work without a mandate, but the only substitute Republicans will vote on this week is a resolution instructing House committees to propose a way to “provide people with preexisting conditions access to affordable health coverage.”

As vague as that provision is, it does seem to rule out the plan Republicans floated last year to rely on state high-risk pools to provide coverage. Such policies are so expensive that few Americans can afford them. And they’ll only become less affordable if insurers continue to shun people with chronic illnesses. The more Americans left without insurance, the harder it will be to slow the unsustainable growth of healthcare costs through new models for delivering and paying for care. The House GOP has acknowledged the problem faced by those with preexisting conditions, but it’s offering nothing specific to help them.