The Pre-existing Condition: Innovative Solutions to America's Thorniest Healthcare Challenge

How to finance care for individuals with pre-existing medical conditions has long been one of the thorniest, most challenging issues in healthcare policy. The Patient Protection and Affordable Care Act’s solution was a vast, complex clockwork of individual and employer coverage mandates, guaranteed issue, modified community rating, multiple subsidies, and other provisions. As commentators spanning the political spectrum warned before the law’s passage, this approach faces daunting logistical and financial hurdles. In a new set of essays commissioned by the Mercatus Center at George Mason University, seven leading policy experts share innovative ideas on how to solve the pre-existing condition challenge. While their approaches exhibit differences as well as similarities, they are unified in their pursuit of a humane, equitable, fiscally sustainable solution to a conundrum that has driven and strained the entire post–World War II healthcare debate.

Charles Blahous is a senior research fellow at the Mercatus Center at George Mason University and director of its Spending and Budget Initiative research program. He has also served as a public trustee for Social Security and Medicare. Blahous specializes in domestic economic policy and retirement security with an emphasis on Social Security, as well as federal fiscal policy, entitlements, demographic change, and healthcare reform. James C. Capretta is a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the Mercatus Center at George Mason University. He was formerly the associate director of the White House’s Office of Management and Budget. He has also served as a senior health policy analyst at the US Senate Budget Committee and the US House Committee on Ways and Means. Tom Coburn served in the US Senate between 2004 and 2014. Before his tenure as one of Oklahoma’s senators, he served three terms in the US House of Representatives. While in Congress, Coburn held seats on the Homeland Security and Governmental Affairs Committee and the Senate Judiciary Committee. Coburn is also a licensed medical doctor. Robert Graboyes is a senior research fellow and healthcare scholar with the Mercatus Center at George Mason University and is the author of the study “Fortress and Frontier in American Health Care.” He earned his PhD in economics from Columbia University. Bradley Herring is associate chair for academic programs, director of the PhD concentration in health economics and policy, and an associate professor at the Johns Hopkins Bloomberg School of Public Health. He has served on the president’s Council of Economic Advisers and currently serves as chair of the Board of Directors for the Maryland Health Insurance Plan. Douglas Holtz-Eakin is president of the American Action Forum policy institute and a former commissioner on the congressionally chartered Financial Crisis Inquiry Commission. He was also formerly director of the nonpartisan Congressional Budget Office and chief economist on the president’s Council of Economic Advisers. Megan McArdle is a columnist for Bloomberg View, where she writes on economics, business, and public policy. She is the author of The Up Side of Down: Why Failing Well Is the Key to Success and founder of the blog Asymmetrical Information. McArdle has also written for Newsweek, the Daily Beast, the Atlantic, and the Economist.