Well that’s…entirely unrelated to most of the other stuff. Retroactively invalidating policies is something that should be against the rules, yes, because insurance is basically gambling and the incentive to cheat and change your bet after the ball has dropped in incredibly large. Ideally, policies should be audited annually and checked for conformance with standards and not invalidated in response to claims. That basically forces the insurance company and the insured individual to put their money in the pot and take their chances for the term of the policy.
I don’t agree, however, that term exemption of coverage for preexisting conditions should be completely outside the scope of action, and I say that as an insulin-dependent diabetic. Every plan I’ve ever been on has a 90-day term where I’m on my own, after which all my prescriptions and any treatments I might need pick back up again, unless I have another insurer provide a certificate of prior coverage. So, in other words, I had to go ninety days once, about seven years ago. If you get everybody covered, that’s going to be the case for, well, everybody, so this can be achieved as a de facto sort of thing without creating an exploitable loophole where your grandma can get a job over at the Piggly Wiggly for a week just to put in for her foot amputation.
Mandating acceptance of all individuals applying for insurance is…a suspect idea. Private insurance companies are still businesses, and any losing case they’re forced to take on is going to have to be paid for out of somebody else’s pocket or they’re not going to be an insurance company for long. I would prefer to see something like the way automobile insurance works in Texas - you’re required to get it or you can’t get a license (so you require proof of insurance for certain government processes, like, for instance, getting a birth certificate, or filing your taxes). The standards for that insurance are pretty low, and there exist a number of companies offering stripped down policies specifically for getting you legal enough to drive. If we can settle on an absolute minimum standard for insurance (I would suggest that it should cover only critical care - not chronic conditions - with the primary goal of the insurance being to minimize how much money you can cost hospitals and doctors who have to stitch you back together after you fall off a freeway overpass or something), a number of providers would presumably pop up to fill that gap and we could at least get the big critical cases taken care of with a standard blanket. It doesn’t do much for ongoing care, but, and I hate to tell you this, neither does putting people on the insurance I’ve got. People don’t go to the doctor because people don’t want to go to the doctor. You’ll find out there’s something wrong with you. If your anus is bleeding or you’ve penetrated your own thigh with a power drill, you’re probably going to go to the doctor regardless - the emergency room, if not a regular provider. There exists a group of people of significant size for whom that will always be the case. Ensuring first that those people are fully covered for their practical use of the system is a good first step towards broader coverage.
That solution, I think, creates a new market for insurance (so the insurance companies won’t fight it too hard), ensures that the biggest critical costs are at least backstopped, doesn’t entirely break the system, and, best of all, doesn’t require nearly as much funding, which is the problem that will absolutely kill the public option at this point (seriously? Medicare savings? You’re financing your plan by saving money from another plan that’s already dramatically over budget? I’d say it’s like robbing Peter to pay Paul, but in this case the only thing being stolen is debt). Couple that with some reforms to get the pricing model for health care under control (do not allow the current caps-plus-annually-shifting-pay-scale thing that all insurance providers do and has led directly to a simple blood test running you three figures when I could run it myself with a microscope and a needle - not sure how the specifics of that would work, but if we don’t do that we’re never going to get costs under control anyway, since the problem is a composite issue between providers trying to make up for the cost of rare procedures by inflating the cost of common procedures as much as possible and insurance companies trying to avoid paying more than a fraction of the stated cost of ANY procedure) and some rules about when you can cancel a policy (basically requiring full coverage for an entire term after the papers are signed by both sides) and I think you’ve got an approach that you could sell to everybody and it’s a good place to start. More stuff might be required later depending on performance, but I think it’s a good compromise that avoids spending metric tons of money and still expands insurance coverage while correcting the worst excesses of the current system. The only other option that I see as working in the long run is a full-on switch over to single payer, and I just don’t believe that there’s any way in hell that will make its way through the legislature, and possibly some militia nutjobs will end up blowing up Congress or some other ridiculousness because that amount of change is a little radical to do all at once.