Republicans Prepare Sleeper Attack On Pre-Existing Conditions Protections

Too many people told themselves this story:

Republicans learned a lasting lesson from the years they spent trying and failing to eliminate the Affordable Care Act. After John McCain memorably turned his thumb down to repeal in 2017, Obamacare was in some sense “safe.” Not immune from Republican vandalism, not immune from modest budget cuts, not politically untouchable—but durable. Something liberals didn’t have to worry about so much anymore

Republicans fed this conventional wisdom by dropping the word Obamacare, and all the negativity they used to heap on it, from their lexicons. No more repeal. No more replace.

Even after Donald Trump won his second term, and ordered up a big bill to cut taxes for the rich and health care for the poor, the words “Obamacare” and “Affordable Care Act” were largely missing from both halves of the partisan fight.

Yes, it’s true that the ACA included a significant expansion of Medicaid, and the GOP legislation moving through Congress would roll that expansion waaaaay back. But while that is a bad idea, and would create a much larger uninsured population, it’s not what most political elites have in mind when they think of “Obamacare.”

To them (to us) Obamacare’s coverage expansion was important, but in some ways incidental to the bill’s more fundamental accomplishment: banning discrimination against people with pre-existing conditions. Illegalizing the pre-ACA practice of pricing people with medical histories out of the individual insurance market, or simply refusing to offer them coverage. Creating something like a right to affordable health care.

Medical bankruptcies, “job lock,” deferred treatment, the psychological agony of uninsurance—Obamacare made all of these problems much smaller. It has been a boon to American liberty. Democrats in 2009 and 2010 could have reduced the uninsured population to a similar degree without prohibiting the status quo barbarism: If they’d reduced the Medicare eligibility age, increased the income threshold for Medicaid, tweaked rules governing employer-sponsored insurance, it would have been a good bill, and reduced human suffering quite a lot, just as the ACA did. But there’d still be a hole in the center of our safety net large enough to swallow many lives; sick people left out of the incremental expansions would have been screwed.

So when Republicans began their most recent crusade against Medicaid, the affront did not feel quite as severe as when they went after pre-existing conditions protections per se. Mitch McConnell knows as well as anyone how hot the politics of health care legislation can get, and even he’s grown complacent.

“I know a lot of us are hearing from people back home about Medicaid,” he told Senate Republicans Tuesday. “But they’ll get over it.”

Well, I have bad news for McConnell: Republicans actually are going after pre-existing conditions protections again—just a bit less directly than before. Here’s how...