JONATHAN CHAIT JUNE 25, 2010
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Even a purist like Marco Rubio wants to keep some popular provisions:
I’m with a small group of reporters in a D.C. coffee shop, chatting with Florida Republican Senate candidate Marco Rubio. He just mentioned that there are two parts within the Obamacare legislation that he doesn’t want repealed*. The first is the ban on insurance companies denying coverage based on preexisting conditions and the second is that he thinks that children up to age 26 should be allowed to “buy into” their parents’ coverage.
Ramesh Ponnuru accurately retorts:
Apparently he wants to repeal Obamacare and then re-pass that provision—although it's not clear from his non-clarifying clarification.
One more time: If you can buy insurance at the same price whether you're sick or healthy, you have no incentive to buy it when it's healthy. Only sick people will buy it, and its price will rise and rise. If you want to have this ban and preserve something called insurance, you have to force everyone to buy it. You can't get this ban on an a la carte menu, as popular as it would be.
Ponnuru is correct. But this also helps explain why NR's crusade for health care reform repeal is doomed. The previous system was intolerable to the public, and only inertia and political dysfunction kept it going. The Republicans had a popular stance of supporting all the popular elements of health care reform, like the ban on preexisting conditions, without any of the unpopular elements. It's a good slogan for building opposition to reform. But it's an unworkable plan for legislation, for the reasons Ponnuru cites.
That's why conservatives have urged the GOP to just support a clean repeal bill, without also having to assemble a majority for an alternative bill. The problem is, that leaves you supporting an intolerable status quo ante. It's so intolerable even Marco Rubio won't endorse it. That's why turning health care reform into "health care repeal" is a winner for Democrats, and why Republican leaders had to be dragged into endorsing it. Repeal divides the GOP base from the center.
6 comments
When even the conservatives' darling Marco Rubio won't support a clean repeal, you know it's dead.
- liberal reformer
June 25, 2010 at 10:35am
Well, in fairness to the Pubbies, the Ryan/Coburn plan has both guaranteed issue underwriting and a ban on pre-existing clauses. It just converts the employer tax exclusion into a $2,300/$5,700 tax subsidy to buy actuarially rated individual health insurance (with its standard, preferred, substandard, gender, occupational, etc. ratings) -- with no requirements on what an insurance policy is required to cover (i.e., DME, prosthetics, maternity care, mental health, prescription drugs) -- on a state-based Exchange. In other words, with the substandard, etc. ratings and no mandated benefits, it takes a few hundred thousand dollars out of the cancer patient's pockets and puts it into the pockets of a bunch of 25-year-old bachelors and insurance executives (and I'm an actuary). Oh, and for cancer, diabetic, and HIV patients, there are those wonderful high risk-pools where you have to go uninsured for six months before you can spend 25-40 percent of your income every single year just to live -- if, and that's a big if, a high-risk pool slot is available to you. ...
- jimbomoron
June 25, 2010 at 12:02pm
Jonathan, I should add that I thought Rubio did a 'Bagger flop on this one. He's back on board with allowing insurance companies to deny health insurance coverage to a diabetic child. So says Daily Kos. ...
- jimbomoron
June 25, 2010 at 12:05pm
D'oh! I stand corrected. I should learn to read your links. What Rubio supports is replacing current law with Ryan/Coburn, which I described above reinstates the gender, substandard, etc. ratings in the individual and small group markets, and revokes coverage of maternity care, prescription drugs, and mental health. And by converting the employer tax exclusion into a standard deduction, the Ryan/Coburn proposal brings everyone in employer-based health insurance -- where those with expensive medical conditions enjoy the community rating and mandated benefits -- into this same individual insurance market. It's a little bit kinder, gentler plan than the 2008 McCain plan but only by a hair at best.
- jimbomoron
June 25, 2010 at 1:02pm
"One more time: If you can buy insurance at the same price whether you're sick or healthy, you have no incentive to buy it when it's healthy. Only sick people will buy it, and its price will rise and rise." I am sorry, but I don't buy this. It is like saying if Car insurance wasn't mandatory no one would buy it until they have an accident, but when you have an accident, it is already too late. You are on the hook for all the costs (provided it is your fault) and people want to protect themselves from that. This bill might mandate covering pre-exiting conditions, but it doesn't mandate paying for pre-existing bills. And there is zero chance that any bill would be written that would do so.
- blackton
June 25, 2010 at 2:52pm
"[I]f Car insurance wasn't mandatory no one would buy it until they have an accident, but when you have an accident, it is already too late." You apparently missed the key words "at the same rate" in Ramesh Ponnuru's column. In the current health care law, an HIV patient and an alcoholic pay the same rate as a triathlete and a cyclist: in other words, the current health care law severely limits an insurance company's ability to price for risk. That is not the case with auto insurance where someone who has had several moving violations and two at-fault accidents in the past three years pays a much, much higher auto insurance rate than someone with no record of moving violations or at-fault accidents. Big difference. And you're comparing apples and oranges when you're comparing auto insurance to health insurance. Auto insurance is mandatory for an entirely different reason that health insurance: the purpose of compulsory auto insurance is to protect the public from the high costs of injuries and property damage resulting from vehicular accidents. You do not have to buy auto insurance coverage on the damage you do to your own body and your own car -- you only have to buy auto insurance coverage on the damage you do to other other people and other cars in an accident, and a very, very minimal level of coverage at that. No auto insurer would sell you auto insurance the hour after you put someone in the ICU with your reckless driving, and the person you put in the ICU could go broke as a result of your negligence. That is why every state but New Hampshire requires every motorist to purchase some level of coverage on the damage done to other people and other people's property. You are not required to purchase coverage on the damage you do to yourself and your property. "This bill might mandate covering pre-exiting conditions, but it doesn't mandate paying for pre-existing bills." Because, unlike an auto accident, it's not anyone's fault that someone has a pre-existing condition. Big difference.
- jimbomoron
June 25, 2010 at 9:37pm