Philip Klein of the Washington Examiner explains in health care terms why there is no such thing as a free lunch.
President-elect Trump has made waves by saying that though he plans to repeal Obamacare, he wants to keep the aspect of it that bans coverage for those with pre-existing conditions. But this is not possible without broader changes to the healthcare system.
The pre-existing condition ban is ultimately one of the primary drivers of the premium hikes we're seeing within Obamacare. The reason is that with insurers forced to offer coverage to anybody who applies, they incur higher medical costs, and they thus require more signups from younger and healthier people — but those signups aren't materializing in a large enough volume to offset costs.
The problem with the pre-existing condition ban is that it's a perfect example of how bigger government begets bigger government. That is, once lawmakers ban pre-existing conditions, they have to come up with a way to make it affordable. Otherwise, insurers could just say, "Sure, we'll cover people with heart problems, but for $2,000 a month."There are some proposed fixes.
1) Have a high risk pool subsidized by the government. (The old it doesn't cost money if the government pays for it trick.)
2) Allow people to sign up only once every two years instead of every year. (Why Avik Roy thinks this would make a significant difference is beyond me. Younger people don't usually think: "I can make it for a year at a time without health insurance, but two years is way too dangerous." I don't think so.)
3) Health status insurance (which is kind of the old catastrophic insurance). (This would bring more people into the insurance pool, but not a lot more money, and it's money that's lacking.)
4) Klein doesn't mention the single payer insurance plan, but some suggest that. Sort of the VA expands to cover everyone. (Given the VA's poor showing in some areas, this probably wouldn't be popular and has the same money problem as idea 1.)
Klein ends with a warning:
So, there are various ideas out there for addressing coverage for those with pre-existing conditions, but it would have to be done as part of a broader effort to replace Obamacare. Republicans couldn't simply repeal all of Obamacare and carve out the pre-existing condition provision without decimating the insurance market.