The now-infamous interview with Fox News' Chris Wallace in which Senate Minority Leader Mitch McConnell said gaining health coverage for 30 million uninsured Americans is "not the issue" revealed yet again how thin Republican ideas for replacing the Affordable Care Act are.
The one staple of Republican proposals, and one that McConnell trotted out in his interview with Wallace, is allowing interstate sales of health insurance.
The thinking is that competition across state lines would drive down prices for the minority of people who buy insurance on the individual or small-group markets, which have been regulated since 1945 by the states. (Employer-sponsored large-group plans, which cover the majority of people, are regulated by the federal government.)
The problem with this line of thinking is that insurance companies are not going to compete for sick customers.
On the contrary, they would aggressively select for the healthiest, leaving anyone who has a pre-existing condition out in the cold.
While those in pristine health might enjoy cheaper premiums, insurance prices would become unaffordable for everyone else.
Plus, those who bought cheap policies would almost certainly be in for a rude awakening if they got sick or injured. Without state regulation and consumer protections, they'd have no recourse.
A more realistic alternative are the insurance exchanges that will give consumers a genuine opportunity to comparison shop for health insurance. The state-based exchanges will begin operating in 2014 under the Affordable Care Act, which also requires insurers to cover people with pre-existing conditions, ends lifetime limits on coverage and has other provisions to guarantee that consumers get good value for their health insurance premiums.
In addition to finding a one-stop source of information, individuals will be able to sign up for private and government insurance programs through the exchanges. Small businesses shopping for employee coverage will gain some of the advantages that have been available to larger employers and will learn whether they are eligible for tax credits under the reform law.
The Affordable Care Act — which, after all, was conceived by conservative think tanks — really does harness the power of the market for consumers.
In Kentucky, the Beshear administration has been dragging its feet on creating an insurance exchange, waiting to see whether the Supreme Court would uphold the health care reform law.
Now that the law has been declared constitutional, Beshear's people should move aggressively. Fifteen percent of adult Kentuckians have no health insurance, by conservative estimates.
The current managed-care Medicaid fiasco should serve as a warning of how badly things can go when health insurance reforms have to be rushed into place.