As the House prepares to vote on the "Repeal the Puppy-Strangling Job-Vivisecting O-Commie-Care Act," or whatever they're now calling it, the White House and its allies actually seem to have their act together when it comes to fighting this war for public opinion. The latest is an analysis from the Department of Health and Human Services on just how many people have pre-existing conditions, and thus will be protected from denials of health insurance when the Affordable Care Act goes fully into effect in 2014:
According to a new analysis by the Department of Health and Human Services, 50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition. Up to one in five non-elderly Americans with a pre-existing condition – 25 million individuals – is uninsured. Under the Affordable Care Act, starting in 2014, these Americans cannot be denied coverage, be charged significantly higher premiums, be subjected to an extended waiting period, or have their benefits curtailed by insurance companies.
As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease. Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state. Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act.
Naturally, Republicans are steamed that the White House would engage in what one GOP House aide contemptuously called "politics and public relations." So let's get down to brass tacks. If the Republicans want to help people with pre-existing conditions, they ought to say exactly how they're going to do it. Everyone who's at all serious about health care understands that you can't cover those who are expensive (i.e. those who are sick or who are likely to get sick) at anything like a reasonable cost without pooling them together with those who are cheap (i.e. the relatively young and healthy). That's why "high-risk pools" that cover only those who are hard to insure just don't work -- they're far too expensive, and manage to cover only a small portion of those who need it. So what's the Republican solution? Let's hear it. They wanted to have this debate, so let's talk about the "replace" part of their "repeal and replace" strategy.
The problem is, you just can't require insurance companies to insure everyone if there's no individual mandate. It just doesn't work. I think most Republicans who have thought about it for more than a moment or two know this. My guess is they're hoping to get this repeal debate over quickly -- they promised to hold the vote, so they're going to hold it -- then they'll go back to talking about the need for tax cuts.
-- Paul Waldman