In a weird spasm of issue-based programming, CNN elected to host a debate on Tuesday night between Sen. Bernie Sanders, D-Vt., and Sen. Ted Cruz, R-Texas, on the topic of health care. Given the ongoing storm and stress over the Affordable Care Act and the shambolic Republican crusade to “repeal and replace” it, an extended public discussion about health care policy between two prominent elected officials is not the worst thing in the world. The debate actually produced some revelatory moments, particularly with regard to the GOP’s plans for people with pre-existing conditions.
At one point early on in the debate, a woman in the audience who had been diagnosed with breast cancer voiced her concern over what will happen if the Affordable Care Act’s pre-existing conditions protections are repealed. She asked Cruz, “What can you do to protect people like me who are alive because of Obamacare?”
Cruz tried to reassure her that with a Republican replacement for Obamacare, people with pre-existing conditions will be protected: “If you look at every proposal that’s been submitted — every significant Republican proposal that’s been submitted to replace Obamacare . . . all of them protect people in your situation. All of them prohibit insurance companies from canceling someone because they got sick; they prohibit insurance companies from jacking up the insurance rates because they got sick or injured.”
Cruz was pressed on this by Sanders and the moderators, who wanted to know if he would insist that a Republican Obamacare replacement include a mandate that people with pre-existing conditions would be protected. Cruz then recalibrated his answer slightly, but significantly. “What I’ve said is virtually all the Republican legislation that has been filed that the Democrats have opposed maintains a continuity of coverage so that insurance companies can’t cancel policies,” he said.
Sanders nodded knowingly as Cruz said this, having caught what Cruz was trying to do. “If you listen carefully to what he's saying, if you go to the doctor tomorrow, and you are diagnosed with a terrible illness, the insurance companies do not have to provide you insurance,” Sanders responded. “That is what Ted said. What he also said, if you have an illness, [insurance coverage] has to be kept.”
“Continuity of coverage” is the key phrase in Cruz’s answer, and it’s the policy idea that Cruz, in his earlier answer, tried to frame as a prohibition on insurance companies discriminating against people with pre-existing conditions.
As Sanders pointed out, continuous coverage proposals are a less comprehensive means of protecting people with pre-existing conditions. To prevent an insurance company from denying you coverage based on a pre-existing condition under the scenario Cruz (very carefully) described, you have to make sure that your health coverage does not lapse for a sustained period of time. If, for whatever reason, your coverage does lapse — as a result of long-term joblessness, for example — then good luck to you because you will once again be subject to the mercies of medical underwriters.
In theory, the threat of being subjected to exclusions for pre-existing conditions is supposed to motivate people to purchase and maintain coverage before they get sick. But, as the Rand Corporation has observed, financial circumstances often force low-income people to go without insurance, and the repercussions of being uninsured could be severe and long-lasting under such a proposal:
Financially vulnerable households might face long-term consequences if insurance is temporarily unaffordable. Of particular concern, job loss often drives the loss of existing health insurance coverage. For families in such situations, the loss of income combined with the loss of employer-sponsored coverage could cause them to be unable to re-enroll in an insurance plan or lead to a sizable increase in premiums.
This is an important point that has to be made clear: When Republicans like Ted Cruz talk about repealing the Affordable Care Act, they are talking about weakening existing protections for people with pre-existing conditions. But Republicans are not going to come right out and say that. Instead they’ll insist that those with pre-existing conditions will be protected while carefully avoiding discussing the ways they’re widening the cracks that many sick people are sure to slip through.