Vance signals new troubles for those with preexisting conditions

After nearly a decade of Donald Trump promising — and failing — to unveil an alternative to the Affordable Care Act, the Republican nominee was asked at least week’s debate, “Just a yes or no: You still do not have a plan?” The former president replied, “I have concepts of a plan.”

Not surprisingly, Vice President Kamala Harris and her party have had some fun with that answer, but alongside the ridicule were some underlying questions: What, exactly, should American families know about Trump’s health care “concepts”? How would the GOP candidate’s “concepts” affect our health security?

The good news is, his running mate offered some answers. The bad news is, JD Vance’s answers were dreadful.

The Ohio Republican appeared on NBC’s “Meet the Press” a couple of days ago, and host Kristen Welker asked a straightforward question: “Senator, can you clarify, what is Donald Trump’s health care plan?” Vance began by telling viewers that the former president rescued “Obamacare,” even though he “disagreed with the original legislation.”

That wasn’t even close to being true. Vance was brazenly lying about events from the recent past that we all saw and experienced. (As a new book explains, this happens quite a bit in contemporary GOP politics.)

As part of the same on-air exchange, the senator also claimed that Trump helped more Americans get health insurance coverage. This, too, was the exact opposite of reality: The uninsured rate went down under Obama, up under Trump, and then down again under Biden.

But the problem wasn’t just Vance’s willingness to tell bald-faced, easily debunked lies on national television. Eventually, the Ohioan managed to say something interesting about his running mate’s policy goals. From the “Meet the Press” transcript:

“What (former) President Trump’s health care plan is, is actually quite straightforward, is you want to make sure that preexisting coverage — conditions are covered, you want to make sure that people have access to the doctors that they need, and you also want to implement some deregulatory agenda so that people can choose a health care plan that fits them.”

The Republican vice presidential nominee added that, under Trump’s preferred model, Americans wouldn’t be put “into the same risk pools.” To bolster his point, Vance added that “a young American doesn’t have the same health care needs as a 65-year-old American.”

I realize this might seem a little wonky, but Vance was actually sketching out a vision in which people with preexisting conditions will be much worse off under Trump.

New York magazine’s Jon Chait explained, “Vance is correct that young people have different needs than old people, and healthy people have different needs than sick people, and putting them all in the same risk pool means charging young people more than they would otherwise pay . … What he doesn’t tell the audience is that allowing insurers to give cheaper plans to the young and healthy means letting them charge more — much, much more — to people who aren’t young and healthy.”

Americans have some experience with this model. It’s the one that existed before the Affordable Care Act became law.

States had high-risk pools to cover people with expensive health care needs — people with preexisting conditions, for example — keeping them out of the patient pools with younger and healthier people. The high-risk pools, however, created dramatic problems for those who needed the most help: Americans with preexisting conditions were stuck with plans they couldn’t afford and benefits that didn’t meet their needs.

The ACA fixed all of this. According to Vance, Trump wants to roll back the clock.

As James Surowiecki explained after the senator’s on-air comments, “In place of the risk-sharing that’s the foundation of Obamacare, Vance’s health care plan would help the young and healthy at the expense of the old and sick.”

It’s a detail voters can and should be aware of as Election Day draws nearer.