Rep. Tom Price (R-GA), the No. 5 House Republican, says he opposes one of the Affordable Care Act’s most popular provisions — a ban on the insurance company practice of discriminating against people with pre-existing medical conditions.
“It’s a terrible idea,” he told Politico.
The remarks reflect a major conundrum for Republicans who, a year and a half after winning back the House, still have no idea how to replace “Obamacare” and are divided over how best to repeal it.
A big complicating factor for the GOP is that scores of rank-and-file members want to repeal the law wholesale, without preserving the well-polling policies. That exposes them to specific questions about the merits of the law’s keys provisions, and gets members like Price, and the rest of the party, into trouble.
A Price aide told TPM in an email that “we can achieve coverage through broader pooling mechanisms, even for those with pre-existing conditions, and tax credits. This should be viewed in the context of Obamacare, which is what we are talking about replacing. In the context of Obamacare, ideas like guaranteed issue and community rating work only if the individual mandate is in place.”
The pre-existing conditions rule is broadly popular with the public, even among Republicans. But the policy will collapse unless healthy people also enter the insurance pool, spreading costs and defraying risks — that’s the purpose of the less popular individual mandate and subsidies that are also a part of “Obamacare.”
Price’s alternative plan would provide consumers tax breaks to make insurance more affordable, and would create subsidized high-risk pools to accommodate the sick and needy. It’s an idea Republicans commonly point to. But it would entrench the very adverse-selection problem that the “Obamacare” mandate resolves. Enrollees would be sick and in need of extensive care, driving up premiums and costs without the counterweight that young and healthy people would provide.
That’s why Republicans are struggling to come up with an alternative they can broadly support: To date, “Obamacare” remains the most comprehensive free-market approach to tackling the free-rider problem while giving Americans a financial stake in their health care.
Sahil Kapur is a congressional reporter for TPM. He previously covered politics and public policy for numerous publications including The Guardian and The Huffington Post. He can be reached at sahil [at] talkingpointsmemo.com.