My representative, Rodney Davis, recently introduced a health care bill “to protect people with pre-existing conditions from discrimination against insurance companies.” (yes, if you think about it, that sentence is poorly written).

I just wrote to him to ask a few details about his plan. I’m sharing the letter below because it demonstrates the difficulty of ensuring that individuals with pre-existing conditions can buy affordable insurance.

“I read about your new health care bill to make sure people with pre-existing conditions can buy health insurance. I’m just curious as to what happens if insurers offer someone who has cancer insurance for, say, $50,000 per year. Would you consider that acceptable? If not, what provisions does your plan have in place to ensure that does not happen?

If your plan has limits on whether insurers can charge different prices based on pre-existing conditions, how will the plan ensure that younger and healthier people do not have a disincentive to sign up because they are being offered insurance at a price that is much higher than their expected healthcare costs?”

There are really only two ways (that I can think of) to ensure that (1) people with pre-existing conditions are not being offered health insurance only at exorbitant prices and (2) you don’t create a “death spiral” where people buying insurance on the individual market are increasingly sick because the healthier people drop out due to rising prices. The first is having an individual mandate (a stick) and the second is a generous tax credit that makes buying health insurance very cheap on the margin even if the pre-credit price is very high (a carrot). I look forward to seeing what Davis’s actual plan is (the “Better Way” Republican agenda does mention a tax credit).