With the popular vote loser insisting that there will be a “wonderful HealthCare package that some very talented people are now developing […] on full display during the Election as a much better & less expensive alternative to ObamaCare,” it’s a good time to look at just what it is Republicans have to replace, and what is it that they have to produce for the 2020 election. This will be a piece-by-piece review in serial form, because that’s just how big the law is. It will serve as a reminder of what’s at stake in 2020.
Let’s start with the one thing that has so dominated the public debate since well before the 2018 midterms: protections for people with pre-existing conditions. It should have been the focus of debate last year, and in the months before the next election as well, because so many people are at risk if it goes away. It highlights one of the important aspects of the Affordable Care Act: It didn’t just secure health insurance for millions of uninsured—it reformed health insurance coverage for just about everyone in the private market. So it’s not just the newly insured population facing the most risk here,. It’s just about everyone.
That’s worth repeating, because we’re going to hear a lot of Republicans who definitely know better, like Mitt Romney, saying things like “Well, let’s begin by putting it in context, which is Obamacare applies to about 20, maybe 25% of the population because for 75 to 80% of the population we get our insurance through our employer or through Medicare or through traditional Medicaid.” That’s a flat-out lie when it comes to the consumer protections of the ACA, because almost everyone receives the protections of the ACA.
That includes roughly 130 million Americans with pre-existing conditions who, thanks to the law, can’t be denied coverage for those conditions. Let’s just remember what the pre-ACA world looked like. Health insurance companies could just flat-out refuse to issue policies to someone with what they deemed a pre-existing condition. Or they could issue the policy, but charge the person a higher premium based on that condition (like the condition of having a uterus and being of child-bearing age). Insurers could also issue policies that excluded coverage for any conditions and refuse to cover any costs associated with treating it.
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