There’s a reason Donald Trump has never produced a health-care plan that protects consumers with preexisting medical conditions: Ending protections for the sick is the central mechanism that all GOP health-care proposals use to try to lower costs for the healthy.
Every alternative to the Affordable Care Act that Republicans have offered relies on the same strategy—retrenching the many ACA provisions that require greater risk- and cost-sharing between healthy and sick Americans—to lower the cost of insurance for healthier consumers. Put another way: Reducing protections for patients with greater health needs isn’t a bug in the GOP plans; it’s a key feature.
“Lowering premiums was a big theme of the Republican effort to repeal and replace the ACA, and central to their idea of lowering premiums was rolling back protections for people with preexisting conditions,” says Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation.
The contrast between the parties over health care is certain to come into sharper relief in the weeks leading up to Election Day, starting with tonight’s first presidential debate between Trump and Joe Biden. Trump’s nomination to the Supreme Court of Amy Coney Barrett, who has openly questioned the ACA’s legality and could provide a decisive vote on the Court against it, ensures that the Senate debate over her confirmation will focus intently on a Trump-backed lawsuit from Republican state attorneys general to strike down the law. With oral arguments for that case beginning before the Court shortly after the election, Biden and other Democrats have stressed Barrett’s potential threat to the ACA, and warned that if the Court overturns the law’s protections for preexisting conditions, insurers would likely treat long-term complications from the coronavirus as a reason to deny coverage.