Obamacare Debate Mixes Apples and Oranges

May 4, 2017

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The Beltway is abuzz. Pundits say the GOP ‘replace Obamacare’ bill will harm people with pre-existing conditions. However, the Obamacare ban on pre-existing condition exclusions -- called ‘guaranteed issue’ – is the cause of harm experienced by millions of Americans.

And as we’ve seen under Obamacare, guaranteed issue makes insurance unaffordable without taxpayer-funded government subsidies. Guaranteed issue of coverage for people with uninsurable conditions is not insurance. It’s government-mandated third-party payment for known medical expenses. It’s socialized medicine.

Health insurance is financial protection against the cost of a catastrophic medical event or chronic condition that you do not yet have, and hope never to get. That’s true insurance and it’s affordable because catastrophic events are rare.

Today’s Obamacare debate is mixing apples (insurance against risk of future medical conditions) with oranges (financing of known medical conditions). As an editorial in The Wall Street Journal notes, “People with pre-existing conditions don’t need insurance—they need help paying for expensive treatment that is already known.”

Republicans are losing the debate because they are not telling Americans how Obamacare’s guaranteed issue mandate raised their premiums sky-high, narrowed their networks, and diminished quality of care. Instead, you hear this:

“I’ve supported the practice of not allowing pre-existing illnesses to be discriminated against from the very get-go.” – Rep. Fred Upton (R-MI), former Energy and Commerce Committee chairman.

“I want it to be good for sick people…It will be every bit as good on pre-existing conditions as Obamacare.” – President Donald Trump on the GOP bill.

“I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered…The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.” – Congressman Billy Long (R-MO)

This may be good political-speak, but it’s terrible freedom-speak.

We must put an end the pre-existing condition problem. “Pre-existing conditions” emerge when children age out of family policies or workers lose employer policies. Congress should target this reality. The answer is personal ownership of lifelong, portable, customized affordable true insurance policies.

Let’s give individuals the same tax deduction that employers get today to buy coverage for employees. Or Congress can end the tax deduction altogether for everyone. On their own, most people would choose affordable catastrophic indemnity (non-health plan) policies, causing costs for minor and routine care to plummet through direct payment. Parents should also be empowered to buy policies for their children pre-birth and hand it off to them at adulthood.

Congress needs to think bigger. Congress should end the problem of pre-existing conditions altogether, and with it, the ‘guaranteed issue’ drive to socialized medicine.

In freedom,


Twila Brase, RN, PHN
President and Co-founder