Obamacare: Popular parts easy, repeal the rest

This week, the U.S. Supreme Court hears oral argument in the cases challenging the constitutionality of the Affordable Care Act. In the court of public opinion, the verdict is already in. From the moment "Obamacare" became law, a consistent majority of the public has favored repeal.

Supporters of the health care law respond that statistics reverse when the pollsters ask about individual features of the act. Always, they point to two popular features: allowing children to remain on their parents' policies until age 26, and forbidding health insurers from denying coverage due to prior conditions.

But, we didn't need Obamacare to accomplish those reforms.

Family coverage up to age 26 is easy and insurance companies have already implemented it at virtually no cost because young adults are generally very healthy.

The second, denial due to prior conditions, had already been reformed under most state law well before the Affordable Care Act passed. Doing so was only slightly more difficult, because it involved a two-part solution involving, first, rescission and, then, denial. Rescission is the cancelation of a health insurance policy if the policyholder misrepresented his or her health on the original insurance application.

Health insurance companies assert a legitimate basis to rescind. Why, for example, should they pay for expensive heart surgery if the policyholder lied about his or her cardiac health on the application? That's almost like applying for car insurance after the crash.

But there used to be a seamy underbelly to rescission where some unethical insurers practiced "post-claims underwriting" - issuing policies to applicants without undertaking the expensive process of reviewing the application in order to make an informed decision to accept or deny the applicant. Only after submittal of a claim did they investigate, searching for any misrepresentation to serve as the basis for denial and rescission of the whole policy - this after having collected a bunch of premium payments.

What's the simple solution? Legislation tightly restricting rescission once the first claim is submitted. Abusive rescissions would disappear, as most already had under various state laws predating the federal health care law and as the rest now have under a similar Obamacare provision. Rescission in the case of fraud has survived.

Indeed, fraud is how we get to the second part of the problem: denial due to prior conditions. People might lie on a health insurance application if they have, or suspect they may have, a prior condition. If they reveal it, they fear being turned down and having no other options.

On the first score, they might be right; likely, they would be turned down, but with good reason. Insurance is protection against the possibility of illness or injury. If a person is already sick or injured, he or she may need coverage, but that coverage is not insurance. It is something else.

On the second score, having no place else to go, they are wrong. Long before Obamacare, 34 states offered programs covering people denied private health insurance due to a prior condition. These heavily subsidized programs, the first of which Connecticut launched in 1976, are misleadingly named "high-risk pools" (again, there is no "risk" because those covered are already sick). These programs covered - and continue to cover - 220,000 people nationwide who have been denied coverage due to a prior condition.

Indeed, "high-risk pools" are such a common-sense approach that they were one of the first features of Obamacare to be implemented. Yes, the health care law doubled down on this practical solution with new federal pools in each state.

But, here's the kicker. While the federal pools have been running for over a year and a half, few have enrolled, only 50,000 citizens countrywide (163 in Connecticut). Why? Perhaps the evil health insurers weren't denying that many people due to prior conditions after all.

Extended family coverage is now in place, yielding Obamacare undeserved credit for so simple a reform. And Obamacare has copied and duplicated, unnecessarily and ineffectively, the common-sense state-law limits on rescission and state-run high-risk pools, once again earning credit it does not deserve. Absent these measures, how popular is Obamacare?

The easy and popular parts of Obamacare have already been implemented; now repeal the rest of it.

Red Jahncke heads the Townsend Group, a business consulting firm in Greenwich and is an occasional contributor to The Day.