I don’t hate to say “I told you so.”
If you want to keep the preexisting-coverage rule — and Republicans say they do — then you are going to end up with Obamacare, or at least a version of it. It might be a slightly better or slightly worse version, but that is what you will have.
For a boring old incrementalist like me, “Slightly Better in 2018!” is a good enough slogan. (We are suspicious of inspiring ones.) But I am not sure that many others will agree.
The double bind remains the same: If you want to mandate coverage of preexisting conditions, then you have to have a general mandate to purchase insurance, or you will simply torpedo the insurance market.
The Republicans’ argument that they don’t really have a mandate does not hold up to much scrutiny: Just as under the ACA, those who go without insurance coverage pay a financial penalty; under the GOP bill, you don’t have to pay that penalty unless you later decide to seek insurance coverage. That isn’t a perverse incentive — it is the Marquis de Sade of incentives.
If you have the mandate and the coverage rules, you have a form of Obamacare.
It isn’t that arguing over the details is unimportant — of course it is important — but you are not enacting fundamental reform of any sort, much less of the market-oriented variety.