Republicans Botch Obamacare Politics in Midterms

In theory, that system would keep premiums lower by deterring people from gaming the system. Healthy people would have an incentive to buy insurance rather than wait until they got sick.

The bill would not have taken people with chronic health conditions back to the situation they were in before Obamacare. Even in waiver states, they would have Obamacare’s regulatory protections so long as they maintained continuous coverage. And it would be easier to maintain continuous coverage than it had been before Obamacare. The bill largely maintained Obamacare’s subsidies for people without access to employer coverage, Medicare or Medicaid.

Those with chronic conditions but no coverage, meanwhile, would have access to government-financed high-risk pools. These pools were, admittedly, oversubscribed before Obamacare. But the subsidies for people in the individual market and the regulatory protection for those who maintained coverage would both work to shrink the applicant pool.

It should also be remembered that, especially in the post-Obamacare landscape, state officials would have a powerful political incentive not to jeopardize affordable coverage for people with pre-existing conditions. The current campaign is itself evidence that the goal of keeping them covered has strong political support.

None of this puts the Republican legislation beyond critique. The Congressional Budget Office, which has long reflected the assumptions of liberal policy experts on health issues, asserted that the waivers could cause serious harm to insurance markets. Its projection, however, partly reflected its confidence that ending Obamacare’s fines on people without insurance — another feature of the Republican bill — would have large destabilizing effects. The CBO has backed away from that view; and anyway, the fines have subsequently been ended in different legislation.

But there is certainly a policy debate to be had on these issues. It’s too bad for the Republican candidates this year that so few of them have shown any ability to engage in it.

— For more columns from Bloomberg View, visit http://www.bloomberg.com/opinion.

Ramesh Ponnuru is a Bloomberg Opinion columnist. He is a senior editor at National Review, visiting fellow at the American Enterprise Institute and contributor to CBS News.