The Affordable Care Act (ACA) dramatically altered the individual insurance market by forcing insurers to insure anyone regardless of health status or pre-existing conditions. It also eliminated caps on coverage.
These changes have been popular. When elected officials say they support banning insurance companies from discriminating against individuals with pre-existing conditions, they are supporting this part of the ACA. One of what many people consider the “good parts” of the legislation.
Here is the rub -- you can’t just keep these “good parts” and repeal “the rest” of the ACA.
This is why: Health insurance is expensive. It is more expensive when medical costs are high and less expensive when medical costs are low. Thus, insurance costs can go up or down based on how small and sick the insured population is. (For the moment let’s leave aside that costs are also dependent on how much we pay doctors and hospitals for their work.)
The big federal government health care programs -- Medicare (about 43 million insured) and Medicaid (62 million) -- tend to have enough people enrolled that there is a predictable mix of the healthy and the sick. For those programs, spending is more dependent on the number of people being provided with health insurance.
You can reduce that spending by...