View: One health care question Republicans must answer

Critics say this approach hasn't worked in the past: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposed a similar protection for people with continuous coverage, and a lot of those with chronic conditions still had difficulty getting insurance. It's hard, the critics add, to stay continuously covered.

But while Walker hasn't spelled out all the details, conservative health reformers have explained how to improve on the 1996 law. That law left people looking for coverage on the individual market without effective protection: Insurers had to offer them policies if they had a health condition, but nothing stopped them from raising their premiums. And customers didn't get the tax break that Americans with job-based coverage enjoy.

These problems can be solved. For one thing, the regulation could be written so that people who had kept coverage would be protected from premium increases. For another, conservative plans like Walker's give tax credits to everyone in the individual market. Continuous coverage, meanwhile, should be defined reasonably rather than strictly. One possibility would be to protect anyone who hasn't gone more than 90 days without insurance over the previous three years. That would probably be enough to keep healthy people from gaming the system.

These people, remember, would have help (the tax credits, the continuous-coverage protection) in staying covered. Insurers would have the freedom and the incentive to design catastrophic policies where the premium equaled the value of the credit, so that people could get and stay insured with no out-of-pocket premium costs. People could choose to purchase more comprehensive coverage and pay the additional premium out of pocket, but no one would have a financial reason for remaining uninsured. If they nonetheless failed to keep covered, they'd still be protected by high-risk pools.

This solution features more federal spending and regulation than conservatives would prefer in an ideal world. But it would be coupled with a major reduction in federal involvement in health care, and especially of federal micromanagement. Walker's plan, for example, gets rid of the individual and employer mandates, the federal definition of essential benefits, and the favoritism for policies purchased through government-run exchanges.

Over time, one could expect the need for the high-risk pools and the regulatory protections to diminish. They address problems that in large part result from the way federal and state policies have stunted the growth of the individual market. Federal tax policy, for example, ensured that employer coverage became the dominant form of health insurance; people who lost such coverage or never had it in the first place have had to seek security in smaller and more fragmented insurance pools. Conservative health reforms — the ones Walker has in mind, and others — are aimed at allowing a more functional market to emerge.

In the interim, Republicans can and should promise to protect people with pre-existing conditions — secure in the knowledge that you don't need Obamacare to do so.

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