On Preexisting Conditions, JD Vance Has the Winning Argument
When asked how people with pre-existing conditions would fare under a Trump-Vance administration during last week's vice-presidential debate, Sen. J.D. Vance, R-Ohio, was unequivocal. "Well, of course, we're going to cover Americans with pre-existing conditions."
The question was prompted by Vance's statement last month that the Republican ticket would consider creating different risk pools for chronically ill people in order to expand the number of insurance choices available to all Americans — rather than the one-size-fits-all status quo under Obamacare.
Democrats seized on the comment, arguing that Republicans wanted to "rip away" protections for those with pre-existing conditions.
But that just isn't the case.
The health policy vision Vance outlined would leave chronically ill patients better off than they are under Obamacare. And it would do so while reducing costs and expanding coverage options for healthier patients.
That progressives have chosen to attack former President Donald Trump and Sen. Vance on this issue has more to do with political tactics than factual accuracy.
Obamacare's requirement that insurers sell to all comers regardless of health status or history and set premiums for the old at no more than three times the level for the young enjoy strong support from roughly two-thirds of Americans.
But by preventing insurers from pricing their products according to the risks they incur covering beneficiaries, these rules raise insurers' potential costs.
And that means higher premiums and deductibles.
In March 2010, Obamacare became law.
In 2013, the year before Obamacare's exchanges opened for business, average individual market premiums were $244 a month.
This year, the average individual benchmark premium was $477 a month.
The average deductible for a mid-level silver plan was more than $5,200 in 2024.
That's more than twice the average for a silver plan in 2014.
Some insurers have opted not to play rather than comply with Obamacare's costly mandates. In 2024, patients in eight states had just two exchange plan issuers to "choose" from.
Another six states had only three coverage providers selling plans on the exchange.
Insurers that remain often compete with one another to avoid enrolling older, sicker people who will need care by limiting the number of providers in their networks.
Nearly 80% of exchange plans restrict beneficiaries to narrow networks, according to research from Oliver Wyman, a consultancy.
In the end, exchange enrollees may be able to secure coverage. But they may not be able to find a medical provider who will see them.
Democrats have papered over the explosion in insurance costs through a series of increasingly generous premium subsidies.
The Congressional Budget Office (CBO) projects that federal subsidies for exchange coverage will cost $1.1 trillion through 2033.
That tab will be even higher if Democrats extend a round of "enhanced" premium subsidies scheduled to expire in 2025.
Democrats in both the U.S. House and U.S. Senate introduced legislation last month that would do just that.
Simply put, the Democrats' solution to covering people with pre-existing conditions has been expensive — and is utterly unsustainable.
A Republican alternative could remove sicker patients from standard insurance risk pools and cover them through a separate, government-subsidized risk pool.
By separating out the highest-risk, highest-cost patients from the rest of the insurance pool, this proposal could dramatically reduce premiums, deductibles, and out-of-pocket costs for millions of Americans who are relatively healthy.
At the same time, it would allow federal assistance to be directed at sicker patients who are genuinely in need of help — instead of wasting billions of dollars on blanket subsidies for all patients, as Obamacare does.
This idea is far from radical.
In fact, something like it has been discussed in conservative health policy circles for years — most recently in the Republican Study Committee's 2025 budget proposal.
Republicans want to ensure that every American has access to high-quality, affordable coverage. Obamacare — with its surging premiums, deductibles, and taxpayer subsidies, as well as its narrow provider networks — has not delivered on that goal.
It's time for a new approach.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.