You can’t just keep parts of ObamaCare and discard the rest

At age 13, I was told by my doctor that I had an aggressive autoimmune disease called psoriatic arthritis. Decades after my diagnosis, I’ve had six major orthopedic surgeries followed by months of physical therapy, more physician visits than I can count and a hefty monthly biologics bill.

{mosads}According to a 2010 analysis by the U.S. Department of Health and Human Services, 129 million Americans have a preexisting medical condition — those, like me, who live with diabetes, cancer, heart disease and arthritis.

Prior to passage of the Affordable Care Act (ACA, or “ObamaCare”) in 2010, it was perfectly legal for insurance companies to refuse to sell me health insurance coverage. If they chose to offer it to me at all, the premiums were so high that I couldn’t afford it on the individual market. The skimpy products available to me had caps that made them something other than real insurance coverage.

President-elect Donald Trump and his Republican allies who run Congress have made repealing ObamaCare one of their top legislative priorities. This isn’t a surprise. Since passage of the ACA, Republicans in Congress have voted 60 times for full or partial repeal of the law.

But following his meeting in the Oval Office last week with President Obama, Trump backed off this campaign pledge ever so slightly.

He told The Wall Street Journal he would “amend, repeal or replace” the ACA. “Amend,” of course, is a term that was never uttered by candidate Trump. But now, the president-elect says he might support maintaining a part of the law that allows young adults to remain on their parents’ health plan until age 26 and another known as “guaranteed issue” that prohibits insurance companies from denying coverage to Americans with preexisting conditions.

This sounds like great news, doesn’t it?

Not exactly.

Despite Republican rhetoric that ObamaCare is a socialistic monstrosity, the foundation for the law — which was borrowed from the plan that then-Gov. Mitt Romney (and later 2012 GOP presidential nominee) signed into law in Massachusetts — is private insurance.

Private health plans that provide meaningful coverage outlined under the law are available for purchase on state-based insurance marketplaces. These marketplaces are designed to resemble how we purchase books online from Amazon, plane tickets from Expedia and car insurance from GEICO.

Here’s the catch.

To provide meaningful health coverage for persons with preexisting conditions and keep the private companies that sell health insurance solvent, you need a balanced risk pool. That’s a fancy way of saying that you need a balance of young and healthy and older and sicker participants in your plan. A plan with only older and sicker participants will quickly go out of business.

So how do you get younger and healthier individuals to buy coverage? ObamaCare’s solution, as it was with Romneycare, is called the “individual mandate.” The mandate essentially says if you decline to purchase health insurance, you will be assessed a minor tax penalty. The law also contains subsidies to help low-income Americans purchase health insurance coverage.

But while the Republicans who run Congress have voted to repeal Obamacare 60 times, there has not been a single vote to replace it.

There are various Republican proposals being discussed that would permit insurance to be sold across state lines (although most plans can do this already but chose not to because of the complexity of having to design plans and build provider networks in far-off states where most providers are already aligned with various insurers); expand access to high-deductible plans with only catastrophic coverage, which generally favor wealthy individuals; and talk of medical malpractice reform.

Right-of-center think tanks champion health savings accounts and other high deductible products that put a large financial burden on individuals, while putting people like me in high risk pools. Before the ACA, many states experimented with high-risk pools and the general experience is that they were more expensive and less generous in their benefits than states projected.

None of these proposals address the problems created by the elimination of the individual mandate.

With Republicans in control of the White House and Congress, they now hold in their hands the fate of 129 million Americans living with a preexisting condition. The Nov. 8 election could be a watershed for these vulnerable individuals.

It is, therefore, vitally important that the patient advocacy community make the preservation of these protections their top legislative priority as we prepare for the start of the 115th Congress.

If patients speak with a unified and clear voice, we can succeed in forcing our elected representatives to put ideology and partisanship aside and work across party lines to find a solution so that Americans with preexisting conditions are never denied health insurance coverage again.

Brennan previously served as Rep. Rosa DeLauro’s (D-Conn.) chief of staff and as legislative director for then-Rep. (and now Sen.) Sherrod Brown (D-Ohio).

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