Republicans who want to repeal the Affordable Care Act—that is, all of them—have a really difficult time explaining how they would preserve popular elements of the legislation, such as the provisions that ban insurers from denying coverage based on pre-existing conditions, or requirements that young people remain covered for longer on their parents’ policy.
In a lunchtime debate on Monday, Josh Mandel, the Republican trying to unseat Senator Sherrod Brown in Ohio, gave easily the most confusing “plan” we've heard so far:
Q: How would you, and with specificity please, how would you maintain those benefits without the requirement of people buying insurance?
MANDEL: Well you have to make cuts in the other part of the government. In order to pay to cover folks with pre-existing conditions, to your question, and for younger folks on their parents’ insurance, if there’s leaders in Washington want to do that without Obamacare on the books—you’ve got to make significant cuts. A lot of Republicans will say, don’t touch defense, don’t touch the military. Listen, if we’re going to have a good-faith conversation about strong health care, about a balanced budget, we need to actually make cuts in defense. I mentioned some of my ideas in respect to Europe. Another place I’d like to cut—I mentioned Pakistan but I’d like to get more specific. A few weeks ago, in Egypt, our embassy was overrun. In Libya our ambassador was killed. Why in the world is Sherrod Brown, and other politicians in Washington, voting to give our tax dollars to countries that harbor terrorists, when we need that money here to pay for healthcare, to protect Medicare, to protect Social Security. It doesn’t make any sense. They’re going to hate us without us paying them to do that. We don’t need to pay them to hate us.
Mandel’s answer, which somehow ends up on the embassy deaths in Libya, betrays a complete ignorance of what “Obamacare” does.
What it does not do is simply pay insurers to cover people with pre-existing conditions. The ACA has an individual mandate to buy insurance, which broadens the consumer pool for insurance companies, while also banning insurers from denying coverage to people with pre-existing conditions and using community ratings to ensure everyone is offered fair prices for coverage.
If you repeal the individual mandate in Obamacare, which Mandel indisputably wants to do, then how do you keep people from simply waiting until they get sick to buy coverage for which they cannot be denied—something that would send the health insurance industry into a fatal tailspin?
That’s what the moderator was clearly asking, and Mandel squares that circle by… cutting defense spending.
It’s a completely nonsensical response. (Brown wryly noted that “That was about a specific an answer on healthcare as he’s given throughout the whole campaign.”) Interpreted literally, it seems Mandel is actually proposing a new federal program that would directly subsidize insurers for covering those with pre-existing conditions and young people who want to stay on their parents’ plans—funded by cuts in defense and foreign aid to places like Libya and Egypt.
But since nobody anywhere has proposed anything like that before—most notably, Mandel hasn’t—what’s more likely is that he’s trading on the common misperception of Obamacare as a massive taxpayer-funded boondoggle that simply throws public money at various problems. Under that understanding of Obamacare, I suppose you could re-fund the “pre-existing conditions coverage” line in the federal budget with defense cuts—but that line doesn’t exist. It’s not how the law works.
Mandel either doesn’t understand that, or wants to willfully mislead voters about the legislation and what he could do for them if it’s repealed.
It’s a tough question for Republicans to answer—Mitt Romney has simply declared that he would magically cover people with pre-existing conditions without offering any details. (This lead an economist at the right-wing American Enterprise Institute to say last week that “It’s a complete mystery what [Romney]’s talking about. He’s clearly asserting that he’s got a new policy, but he hasn’t said what it is.”)
Given how ridiculous Mandel sounded while attempting to flesh out a plan, perhaps Mitt is onto something here. But the bottom line remains that Republicans like Mandel and Romney have no serious plan for maintaining coverage for people with pre-existing conditions.