Making insurance affordable means more people have insurance. Eliminates much of the ER expense, except the problem along the border.
Honestly, not knowing the numbers of people that are mensurable due to pre-existing conditions, I don't have an answer, but I'm sure there is a workable solution. Maybe each insurance company would take a portion based on revenues, or a national pool to cover a percentage. I bet if it was debated on the floor of the house, they could come up with something.
But you aren't mandating that they purchase a health care product for a service, by law, that hospitals have to provide for you if you need it.
The flaw in this entire debate, especially from the Republican side, is that the assumption is that if you make health insurance affordable, people would buy it. You're assuming people are that intelligent and cognizant of how it benefits them, and society, by purchasing health insurance.
Considering how most Americans handle their money, this is a very dangerous assumption. Especially in the younger demographic. A lot of them have never seen an ER bill, so they don't realize how quickly that visit goes from $0 to $3000. Therefore, you're looking at putting younger folks in serious financial trouble if they need to go to the ER, and if you're the kind of person who can't afford even the most basic insurance, you're not going to be able to handle a bill of that magnitude. And even if the hospitals put you on a payment plan, they will send you to collections if you can't pay.
To say that this isn't a big problem in non-border states is ridiculous. Go to a county hospital in a major metropolitan area and sit in an ER for a couple of hours (I have. Many times.). Then, tell me if a lot of the people who are receiving treatment they can't pay for are undocumented immigrants.
As far as pre-existing conditions are concerned, I don't want the House to debate anything regarding this. Republicans and Democrats couldn't find the right solution for anything if the correct answer was sitting there, naked, in the middle of the chamber, with a gigantic neon sign over it that said, "Hey, jackasses, I'm right here." You're better off with a simple mandate that can't be corrupted by loopholes. Besides, if everyone supposedly has the "right" to healthcare,which is mandated by law already, and we all agree that the more people who have insurance is better for the whole, it's best to make the insurance companies pay for it. We're all paying for it anyway when the diabetic goes into cardiac arrest and goes to the ER for a long acute care stay that they'll never be able to pay for (since they couldn't get coverage because, hey, who wants to insure someone in their thirties with Type 2 diabetes?), and at least if the person had insurance, the insurance company would be able to work with the hospital to negotiate a lower rate for the stay.
The simplest way to break this problem down is to decide whether or not health care is a "right". And, depending on how you interpret the Constitution, you'd say that the government mandated that we're all entitled to "Life", hence why a hospital can't turn anyone away if they need it. So, if we all agree that hospitals shouldn't turn anyone away, regardless of whether or not they can pay for it, and we're all better off, financially, if people pay for it, then somehow, logically, you need to address that gap. And if the government tries to mandate people buy health insurance to fill that gap so we all benefit as a whole, I don't see how that's unconstitutional since one person's decision NOT to buy health insurance impacts you, me, and every other taxpayer out there. Especially when the retort to this mandate is to simply lower the cost of insurance so people can buy it. Well, yeah, that would be great, but even if you do that, there is no guarantee that A) people would buy it because, let's face it, most people aren't blessed with the brains God gave a piss ant, B) if you don't make it illegal to refuse someone based on pre-existing conditions, and C) you eliminate the cap limits that some of the folks with chronic conditions will ultimately encounter due to the cost of treating their illness over the course of many years.
I'm all about ways to reduce the cost of insurance. I'll listen to all sorts of ideas. However, I absolutely believe in a mandate for citizens to purchase it. There is absolutely no harm in telling someone to do something when their inability to do so costs all of us.