Voters should call out duplicity on pre-existing conditions

Imagine a Republican candidate saying into the camera:

“As a conservative, I believe in market-based health care.

I’m sorry if you were born with a pre-existing medical condition that makes you uninsurable, but how is that the responsibility of your fellow taxpayers?

This is between you and the free market. Good luck.”

You won’t see that ad, of course. Yet it’s what pure free-market health care would look like — and somewhat did look like before the Affordable Care Act, or Obamacare, when insurance companies could refuse coverage to people who were already sick. Polls show Americans won’t tolerate going back to that.

Thus the incoherence, evasion and outright deception by Republicans as they continue their assault on Obamacare. They insist the free market can replace the guaranteed coverage they’re trying to kill, albeit without explaining how such a magical feat can be accomplished.

They’re offering not policy, but alchemy. Voters should call them out.

Insurance uses premiums of healthy people to cover expenses of sick ones, with the company reaping what’s left. Just requiring companies to cover people who are already sick would invite the healthy to skip buying insurance until they need it. Profitability would become impossible. Simply put, the free market isn’t equipped by itself to guarantee coverage of pre-existing conditions.

So Obamacare required everyone to buy insurance, giving the companies a big enough pool of profitable customers to cover the ones with pre-existing conditions. It’s clunky, but if you insist on putting the square peg of health care into the round hole of the free market, this is how it works.

Unless, of course, you’re willing to tell people with pre-existing conditions they’re just out of luck. That would be truly free market; it would also be political suicide. So Republicans are trying to have it both ways, vowing to protect guaranteed coverage while working to remove it.

That was the central deceit behind last year’s Republican repeal-and-replace bill. It guaranteed coverage, but eliminated Obamacare’s limits on premiums — meaning those rates could be set prohibitively high to keep sick patients out.

If Republicans are serious about protecting coverage of pre-existing conditions as they continue their assault on Obamacare, they need to explain how they will do that. If they cannot — and so far, they can’t — then voters should assume that behind their empty rhetoric are the words they’re not airing: This is between you and the free market. Good luck.

— The St. Louis Post-Dispatch