For years, Republican reformers had adopted a relatively consistent approach to those with pre-existing conditions. Instead of simply requiring insurers to cover those with pre-existing conditions, which has many spillover effects, Republicans had long argued for dealing with the issue of pre-existing conditions in a more targeted way so that the market could function more regularly for the broader population. Typically, the solution has been in the form of subsidized high-risk pools that would offer an alternative path to coverage for those with high medical costs. By removing these individuals from the broader market, healthier individuals would be able to choose from a wide array of plans for less money at benefit levels of their choosing.
Republicans, prominently with House Speaker Paul Ryan’s “Better Way” proposal last year and with President Trump’s boasts, chose to abandon their long-standing approach to pre-existing conditions and embrace Obamacare’s approach instead. Once they did that, it effectively became impossible to truly repeal Obamacare. But Republicans are still dedicated to being able to claim that they passed something they can call repeal. So their solution has been a piecemeal approach — picking off parts of Obamacare, many of which were in place to offset the effects of denying bans on pre-existing conditions.