With Obamacare, you know what you’re getting. Trump plans to replace it with an ill-defined “concept.”
Prior to Obamacare, the attitude of Republicans was that health care was a luxury of the well-off; tens of millions of Americans couldn’t afford, or couldn’t get, health insurance; and medical bills were the leading cause of personal bankruptcy in the U.S.
Obamacare changed all that, but Republicans still don’t like it. But it’s too popular to get rid of. And one of Obamacare’s most popular features is that insurers can no longer delve into enrollees’ medical histories, deny coverage for pre-existing provisions, or charge higher premiums based on health history.
This approach is based on standard insurance principles: Most people’s houses will never burn down, but they all pay premiums into an insurance pool, which provides funds to make whole those whose houses do burn down.
The bulk of most people’s lifetime medical expenses occur in old age. Young workers who pay Medicare taxes are, in effect, paying the medical bills of those who’ve grown old and sick. Their turn will come when they, too, are old and become consumers of medical care.
Similarly, young and healthy people pay into Obamacare to pay the medical bills of those who are sick. In order for everyone to pay an affordable premium for health insurance, the healthy have to subsidize the sick. In return, they get a guarantee that if they become sick, their medical bills will be paid by pooled insurance funds, instead of devastating their personal finances and assets.
The guarantee of Obamacare is that no one will face bankruptcy and loss of their life savings because of medical bills.
J. D. Vance wants to split the people covered by Obamacare into high-risk and low-risk pools, with different premium rates. He claims insurers would still be required to cover pre-existing conditions — but they would be allowed to charge those insureds higher premiums. In exchange, young and healthy people would get lower premiums. This is superficially appealing to that group of voters.
But it effectively undercuts Obamacare’s greatest promise: That the sick will be cared for, without bankrupting them. There is no way Vance’s scheme can work without charging less-healthy people higher premiums, and for many, that insurance will be unaffordable. America will again see medically uninsureds, and medical bankruptcies.
There’s nothing new about Vance’s health insurance scheme. Republicans still oppose Obamacare. They still want to take America back to the bad old days of pre-existing conditions, unaffordable health insurance, and medical bankruptcy.
And that’s exactly what the health insurance scheme Vance is creating to fill in the specifics of Trump’s “concept” would do. Nothing has changed; Republicans, Vance included, are still pushing their stale old ideas.