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Paul Ryan has a message for those with pre-existing conditions

Dear Americans with pre-existing conditions: Speaker Paul Ryan has a health care plan you're probably not going to like.
Rep. Paul Ryan (R-WI) at the Iowa GOP Lincoln Dinner at the DoubleTree by Hilton in Cedar Rapids, Iowa April 11, 2014.
Rep. Paul Ryan (R-WI) at the Iowa GOP Lincoln Dinner at the DoubleTree by Hilton in Cedar Rapids, Iowa April 11, 2014.
After seven years of waiting for a Republican alternative to the Affordable Care Act, House Speaker Paul Ryan (R-Wis.) at least claims to be moving closer to a resolution. The GOP leader appeared on MSNBC yesterday and said his party's plan might even be ready in time for the Republican National Convention, which begins in July.
There's ample reason for skepticism, but who knows, maybe Ryan will manage to pull something together. But while we wait, it's worth appreciating the fact that even if an "Obamacare" alternative emerges -- it's unlikely, let's imagine it for the sake of conversation -- Americans probably aren't going to care for it. Consider this new Reuters report:

U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare's financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools. In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.

"Less than 10 percent of people under 65 are what we call people with pre-existing conditions, who are really kind of uninsurable," Ryan told a Georgetown University audience yesterday. "Let's fund risk pools at the state level to subsidize their coverage, so that they can get affordable coverage. You dramatically lower the price for everybody else."
Ryan doesn't talk about health policy details often, so these comments were a welcome contribution. They were also an important hint of what's to come.
Let's acknowledge at the outset the Speaker's assessment contains a kernel of truth: protecting Americans with pre-existing conditions, as the Affordable Care Act does, raises costs. If policymakers were to decide they were prepared to simply leave these Americans behind, you could, in fact, "dramatically lower the price for everybody else."
But Obamacare is predicated on the assumption that dumping millions of Americans with pre-existing conditions -- folks who couldn't afford coverage before the ACA passed -- into high-risk pools is the wrong thing to do. The Affordable Care Act guarantees protections, which ends up costing more, but which provides greater and more stable health security for more people. It's a trade-off based on a moral calculus.
And as it turns out, polling shows these protections are among the law's most popular provisions. Ryan assumes that Obamacare is so widely disliked that the public will rally behind a far-right alternative, but what he doesn't fully appreciate is the fact that the GOP solution is going to make the Affordable Care Act look even better.
Not to put too fine a point on this, but the Speaker's rhetoric at Georgetown was effectively an endorsement of insurers discriminating against the sick. Just imagine the savings!
As for the high-risk pools Ryan envisions for the millions of Americans who used to be "kind of uninsurable," wonks sometimes refer to these pools as "health insurance ghettos" for people with pre-existing conditions. They could create a coverage option for these Americans, but they'd cost a small fortune -- and congressional Republicans have said more than once that they have no interest in paying for them.
If they're part of the foundation for Ryan's elusive ACA alternative, health-care proponents are going to have a delightful time comparing Obamacare to its Republican rival.