Repeal and Pretend to Replace

Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico. It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill.

The Republicans would reportedly like to maintain the provision that allows young people to stay on their parents' health insurance until they turn 26 and rules that close a donut hole on Medicare's prescription coverage. Most notably, they would also reinstate the ban on insurance companies denying coverage based on preexisting conditions.

That last part reveals why these Republican overtures are not serious policy considerations, but rather grandstanding to protect their image. It is impossible to imagine any scenario where the current crop of GOP House representatives accept the tradeoffs necessary to force insurance companies to accept all applicants. As the law currently stands, the preexisting condition ban and the individual mandate are inseparably tied to one another. Without the mandate, the most rational decision for consumers would be to hold off on purchasing insurance until they become sick. However that would create a spiral of increasing costs, as the only people in the insurance pool would be those who require the highest levels of health expenditures.

Though it was originally a conservative proposal, the right has vilified the individual mandate as the utmost evil of government overreach. The Republicans will most likely point to Obama's own opposition to the mandate during the 2008 presidential campaign. At that time Obama attempted to separate himself from the similar plans offered by his Democratic opponents by suggesting the mandate would be unnecessary. Instead, Obama's campaign suggested most consumers would enter the health insurance market if the government offered high enough subsidies to lower the cost for people who currently struggle to afford coverage. The Affordable Care Act implemented some of those ideas, expanded the range of people covered by Medicaid, and providing subsidies for the middle class that will kick in starting in 2014, but even then the administration was forced to recognize that too many people would sit out if the bill didn't include a mandate. Since Republicans would be unlikely to reinstate those subsidies, they've shutoff the possibility of helping people with preexisting conditions.

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