Health care bill is the right kind of progress

Shortly after Barack Obama’s inauguration in 2009, the news U.S. president introduced a federal budget that, among other things, set out Obama’s “principles“for health care reform. Obama promised to “Provide Portability of Coverage,” saying that “People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of pre-existing conditions.”

On Thursday, House Republicans passed a health care bill that fulfilled both of Obama’s heartfelt “principles” of eight years ago. And yet while Democrats in 2009 would have built a statue outside the White House if Obama had fulfilled this promise, liberals spent most of this week accusing Republicans of wanting to see people die in the streets.

The problem, of course, is that in the intervening eight years, America has been wrangling with Obamacare, which not only mandated coverage of pre-existing conditions, but also drastically limited what insurance companies could charge this expensive class of customers (a practice called “community rating.”)

If insurers can’t charge extra for consumers who cost them more money, then they need to make that revenue up somewhere — which forced enactment of perhaps Obamacare’s most unpopular provision, the mandate that all individuals buy health insurance or pay a penalty. On top of that, premiums began to rise sharply and insurance companies started fleeing the program; in the last month, three major health insurers have announced they are pulling out of Iowa, leaving individual policyholders with zero coverage options in the state.

And yet by trying to fix this morass that Bill Clinton once called “the craziest thing in the world,” Republicans are now held out as bloodthirsty vampires capable of inflicting untold horrors on the sick.

In short, for Republicans, Obamacare’s provision on pre-existing conditions has become a pre-existing condition.

But while the House’s American Health Care Act (more accurately titled the “Hey, We Passed Something So Get Off Our Backs And Start Bothering the Senate Act”) can still be improved, the provision on pre-existing conditions is one of the cornerstones that should stay.

What the AHCA essentially does is require insurers to separate out their most expensive customers and charge them a rate that more accurately reflects their cost. And, yes, in limited cases this means some people could pay more based on health factors beyond their control. However, the bill also provides $138 billion over 10 years in funding to help keep costs down for these people in “high-risk” pools, many of which will be set up by states that apply for waivers from the existing health care law.

Basically, the only people

who will be affected are the small group of people who live in states who apply for the federal waiver from Obamacare’s pre-existing condition rule, who actually have a pre-existing condition, who have let their existing insurance lapse for longer than 63 days, and who are looking for insurance in the individual market.

That doesn’t mean the AHCA can’t be improved. For lower income individuals who make just slightly too much to qualify for Medicare, the tax credit the AHCA provides may not be enough for them to find an affordable plan. But at the very least, the bill could, as suggested by Ramesh Ponnuru at National Review, require insurance companies to offer a basic plan that matches the amount of the tax credit.

Further, there should be enough funding available to truly offset the cost of people in the high-risk pools; taking care of them will ease the burden on everyone else in the private markets and lead to a more vibrant, flexible system.

Of course, Democrats and Obama enthusiasts will portray the new health bill as a step backward. Importantly, the Senate still will have its say and we don’t know what its version is going to look like, or how it will be negotiated with the House’s version of “Terrificare.”

But ultimately, whatever passes will be a retreat from a plan that didn’t work. And in that sense, it represents the right kind of progress.

Christian Schneider is a Journal Sentinel columnist and blogger. Email cschneider@jrn.com. Twitter: @Schneider_CM