insurance coverage and handled differently. If it's pre-existing, it's by definition not insurance. I don't know what the right answer is, but you can't expect insurance companies to just "suck up" the cost of covering pre-existing conditions within existing premium levels. So step 1, you need to put teeth behind the requirement that everyone has insurance... if you can do that, the pre-existing condition issue largely goes away because everyone ultimately is insured and there's really no such thing as a pre-existing condition. The condition is covered by the insurer at the time the condition came into existence.

In the meantime, perhaps there could be some sort of medicare for pre-existing conditions that people could buy into if they were unable to secure traditional insurance at a reasonable price... sort of along the lines of Citizens insurance in Florida (no private insurers will write windstorm policies east of US-1, so the gov't of florida created Citizens to provide coverage to high risk properties... but you're only eligible for Citizens if you cannot get insurance through a private insurer).

Ultimately, I think the long term solution is medicare for all (i.e. universal coverage) with very low, basic reimbursement rates that providers are free to accept or are free to charge a premium on top of. There will be market of providers that accept the basic reimbursement rates (probably with a lower level of service... longer wait times, more use of PA's/Nurse Practitioners, virtual visits, etc) and providers who charge a premium for higher levels of service. I think that will satisfy the goal of efficiently covering everyone, while also addressing the concerns about service levels under universal coverage for people who currently have very good coverage under the existing cluster-f of a system.