Voices from the left keep insisting that universal coverage and a single, all-inclusive risk pool is “just insurance,” and that anyone standing in opposition just “doesn’t understand insurance.” The argument is usually extended to the idea that all individuals must receive and pay for a comprehensive set of benefits, going far beyond any reasonable notion of catastrophic coverage. Proponents of this view advocate an extreme form of socialized health coverage that eliminates private choice and traditional risk-rating.

In a free society, individuals cannot be coerced into cross-subsidizing activities that might violate their religious convictions. It is hoped that this will be affirmed by the Supreme Court’s Hobby Lobby decision, likely to be issued this Monday.

Likewise, in a free society, individuals should not be forced to cross-subsidize private choices made by others. Preserving the right of individuals to purchase the benefits and coverage levels of their choice at reasonable premia (e.g., catastrophic care only or “wellness” features, no pregnancy coverage for senior citizens, risk-based pricing) is crucial. Providing care for high-risk individuals with pre-existing conditions need not involve a dismantling of the private health insurance market.

Of course, Obamacare has fallen short of the socialist “ideal,” either before or after all of the exceptions, delays, and waivers made by the administration and HHS. Its design, nevertheless, has had a destructive impact on the private insurance market, and the program is straining under the effort to provide high-risk coverage. In “Obamacare’s Prognosis Grows Dimmer,” Lanhee Chen discusses how adverse selection is playing out on the Obamacare exchanges. Based on the evidence available thus far, the exchanges appear to be laden with a high percentage of sick individuals. This is likely to lead to more premium shock for enrollees as we head into the mid-term elections.

A path toward providing effective coverage for pre-existing conditions is discussed in this article. It asserts that a solution hinges on the ability for individuals to make seamless transitions between employer-provided coverage and individual coverage, even with pre-existing conditions. Since that ability must apply nationwide, the authors also assert that there must be a role for federal funding of the high-risk pool of individuals making the transition to the individual market.