The least popular part of Obamacare has been the individual mandate. It does not affect those with group insurance. It does not affect those with individual coverage.
It does not affect those who cannot afford coverage, since that would be provided. As it turns out, providing insurance coverage is far less expensive than providing care at the emergency room.
In fact the tax-penalties-that-are-not-tax-penalties-don't-call-them-that involving the insurance mandate will affect, at most, one percent of Americans. Still, requiring insurance coverage does strike some as onerous on principle.
The most popular part of Obamacare remains the prohibition against turning down those with pre-existing conditions. To most who have kept up on the issue, the two are inexorably intertwined. If insurance companies cannot discriminate against those already ill, or with histories of illness, there is no reason for anyone not yet in need to pay premiums. We all can just order up insurance when it is time to get treatment.
Health insurance companies would go out of business.
Is there an alternative? Although Republicans are tending toward Repeal and Go Back, Representative David Drier (R-CA) seems to be in the shrinking Repeal and Replace wing of the GOP. He suggests something already in temporary existence. It is modeled after procedures in 35 states. Those states have high risk pools that provide coverage to those with pre-existing conditions. Coverage is expensive. There are limits. There are waiting periods. There are deaths among those in that waiting period, and more among who can't afford the extreme premiums, and still more among whose treatment goes beyond the limits.
But it does provide some relief for those who have no other way. "I believe my state of California has a structure in place to deal with pre-existing conditions," says Representative Drier. "It’s a pooling process, which I think is one worthy of consideration."
The federal government has a more comprehensive temporary insurance pool for high risk people who cannot get coverage. It is a lot like those state agencies. It is a short-term part of Obamacare. It will fade out as other provisions faze in, and pre-existing conditions disappear as a concern.
Republicans held hearing yesterday on how they might dismantle Obamacare. There was some discussion about whether to find ways to continue coverage of those with pre-existing conditions.
Representative Drier, although he did not offer specifics, seemed to suggest making the temporary insurance pools permanent. He would like the issue of pre-existing conditions addressed, but there should be limits. He spoke directly of those whose needs will not be met by insurance pools. He offered one hypothetical example:
"I don’t that think someone who is diagnosed with a massive tumor should the next day be able to have millions and millions and millions of dollars in health care provided," he said.
It is a drawback of sorts. There are, of course, other examples that will not be hypothetical to families who encounter them. Without universal coverage of some kind, those with more serious conditions; children, the elderly, those in between; or those who cannot afford highly expensive pooled premiums, will have to be discarded.
"We must redouble our efforts to repeal and replace this law with patient-centered reforms that will reduce costs," says Representative Drier, "and help the American people meet their healthcare needs."
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