The New Republic

So predictable. And so wrong.

Both Aetna and Humana have announced that they will follow the example of UnitedHealth, keeping in place some of the Affordable Care Act's provisions even if the Supreme Court strikes down the law. Sure enough, Republicans are calling this proof that the insurance marketplace works and that Obamacare is unnecessary.

Via Joanne Kenen and Jonathan Allen of Politico:

“Today’s announcement is a reminder that sensible health care reform does not require the massive government takeover in Washington Democrats’ law, which is hurting our economy by driving up costs and making it harder for small businesses to hire,” said Michael Steel, a spokesman for House Speaker John Boehner. Steel added that the private insurers’ action “reinforces our commitment” to repeal any portion of the law that the court leaves standing.

Rep. Jo Ann Emerson (R-Mo.) offered a similar view. “There is plenty of room for solutions in the private market, and a primary objection to the ACA remains the heavy-handed, bureaucratic approach, which necessarily compels millions of employers and beneficiaries to leave private insurance in favor of a public option,’” she said in an email.

Just to review, the provisions those insurers have agreed to preserve represent only a small piece of health care reform. It's great that young adults will get to stay on their parents' policies: As a new study from the Commonwealth Fund revealed, as many as 6.6 million young Americans have gotten insurance coverage because of that provision. And it's great that these insurers are willing to end lifetime limits on benefits. The people who would hit those limits are people with the most serious, long-term medical conditions—in other words, the ones who in most cases are most in need of financial protection.

But the insurers and their Washington representatives have been very clear about one provision they will not be preserving on their own: Coverage for children with pre-existing conditions. 

The insurers also won't be putting in place the much larger reforms to come in 2014: Federal subsidies, so that people buying insurance on their own get assistance as long as they are making less than four times the poverty line; guaranteed coverage, at uniform rates, for adults regardless of pre-existing conditions or medical risk; expanded eligibility for Medicaid, so that anybody making less than 133 percent of the poverty line can get coverage directly from the government; minimum benefit standards, so that nobody discovers their policy doesn't cover basic treatments; and many others.

They aren't doing any of these things because, as a practical matter, they can't. All of them require fundamental, structural changes to the insurance market, along with government subsidies (with the cuts and revenue to finance them). Only comprehensive health care reform, like the kind the Affordable Care Act delivers, can do that. 

By the way, whether other insurers will follow suit remains unclear. From Politico's Jason Millman:

The Blue Cross Blue Shield Association stopped short Monday of making a full commitment to joining the other major insurers. BCBSA said it will "encourage its 38 local [BCBS] Companies to offer the broadest set of protections possible at an affordable price. Plans will be responsive to their members and the communities they serve." Meanwhile, WellPoint said it's waiting on a Supreme Court ruling before making anything official. "We remain focused, first and foremost, on meeting the needs of our customers, and we will announce our specific plans in this regard shortly after the court issues its ruling," spokeswoman Kristin Binns said. Cigna earlier in the day declined to comment on post-SCOTUS plans. 

Oh, and a reminder to the staff of Rep. Emerson or whoever is writing her talking points: The law has no public option. I wish that it did.

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