Instead, the Trump administration, Florida, and 19 other states are fighting in court to make it permissible business again

Imagine this scenario. Flagler County Sheriff’s deputies are arresting a man for domestic violence. They read him his Miranda rights. Then they ask him a question: Have you been arrested or found guilty of any crime before? The man says yes, he has. A couple of times. Ah, in that case, the cops tell him, you’re free to go. We don’t arrest people with a pre-existing record, only those with a clean record. Makes our life easier and we don’t have to waste time and money on you losers.

That, of course, would be absurd, insane, and unacceptable. But it’s exactly what health insurance companies used to do with people who have pre-existing conditions, and it’s what they want to do again: Insure those who are well. Let those who are not fend for themselves. It’s as retrograde a reversal of what health insurance is intended to be as if law enforcement were to arrest only first-time offenders and let repeat offenders go on their way.

We’d never accept that from police chiefs and sheriffs. Why would we accept it from politicians and state government agencies? But we are.

Last month the Trump administration filed a court brief, joining 20 other states, Florida among them, in a lawsuit that seeks to throw out the requirement of insurance companies to cover pre-existing conditions. The states are actually arguing that Obamacare is entirely unconstitutional. The Trump administration isn’t going that far. It doesn’t need to. It’s done plenty to plunder the Affordable Care Act as it is, eviscerating so many of its provisions—cutting off subsidies, aborting birth control coverage, curtailing enrollment helpers, and actually shutting down the Obamacare website periodically (shutting down a website?), among other gouging—that the law is already an invalid hobbling in most states. But covering pre-existing conditions had become a moral red line. Then again, moral lines are mere squares in Trump’s hopscotch, there to be hopped on the way to sadism’s plum pudding.

There are many reasons to dispute the validity of Obamacare. The requirement to cover pre-existing conditions is not among them. It is the most popular provision of the 2010 law, because it’s its most effective one. Without it, Americans would go back to the days of bankruptcy by illness, and worse. No coverage doesn’t mean no care, but it means less care, much less preventive care, and more early, unnecessary deaths. As Jimmy Kimmel famously said after his son’s emergency heart surgery last year, “if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.” Covering pre-existing conditions is also a principal reason health insurance exists, at least anywhere civilized health insurance exists: Life is a pre-existing condition. The rest is endurance.

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