Among the most vexing of our national health care policy challenges is the question of who should pay (and how) for the medical care of those with pre-existing health conditions. Advocates propose a broad array of answers to this question, explanations of which rapidly grow complicated. The purpose of this column is to simplify as much as to explain – to provide a cursory thumbnail guide to the basic value judgments underlying these complex proposals.
Disagreement over how to handle pre-existing conditions is a big part of how we came to our current impasse over national health care policy. The promise that the Affordable Care Act (ACA) would guarantee coverage for those with pre-existing conditions was one of the most popular provisions of an otherwise unpopular law, and a central motivation for its passage. Donald Trump, while a candidate for president, expressed support for maintaining a pre-existing condition coverage guarantee even as he opposed the ACA as a whole. More recently, congressional Republicans have been working to bridge internal differences over how to handle pre-existing conditions in a repeal-and-replace bill, resulting in the draft MacArthur amendment to the AHCA.
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