With House Republicans hell-bent on careening over the health care cliff, it’s worth discussing the issue that’s greasing the skids: pre-existing conditions. Yesterday, Paul Ryan picked up a few votes for the tax-cut giveaway bill (the ACHA) disguised as health care “reform. The GOP agreed to add an additional $8 billion over 5 years to cover people thrown into “high-risk pools” due to their pre-existing conditions. It’s not a fix: it’s a scam. Here’s why.
Although AL-05 Congressman Mo Brooks (202-225-4801) appears think that sick people have brought it on themselves through poor life choices, he is – once again – woefully misguided. Our society no longer operates under the ancient view of illness as punishment from the gods. No, we’ve moved “forward” and now embrace the insurance company view of illness.
There’s no longer a reason for God to notice your misdeeds and punish you. Pre-Obamacare, insurance companies were more than willing to judge you, charge you, and deny you coverage. Their cloak of respectability was pre-existing conditions.
The bill that House Republicans hope to pass will gut the ACA protections for people with pre-existing conditions. That means pretty much everybody in the country, y’all!
In 2011, the Centers for Medicare & Medicaid Services (CMS) estimated that half the people in the country may have at least one pre-existing condition.
As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease. Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state. Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act.
If the Republicans roll back this protection, understand that anyone trying to buy insurance will have a target on his/her back. There’s no concrete definition of a “pre-existing condition:” it’s whatever the insurance company says it is.
Here’s your average person’s view of a pre-existing condition:
- High blood pressure
- Congenital illnesses
Here’s how insurance companies, pre-Obamacare, defined pre-existing conditions:
- All of the above stuff
- Domestic violence – those trip to the ER don’t come cheap, lady.
- Plans to adopt children in the future
- Mental health therapy
- A “dangerous occupation” such as police office, fire fighter, or migrant worker.
- Anything else they could make up.
Insurers defended themselves, saying that people needed to take responsibility for their health care and not wait until they got sick to seek coverage. That’s reasonable, but the companies’ behavior invalidated the assumption that people could get insurance even then they were healthy.
Companies routinely wrote “exclusions,” for specific illnesses – even if the person wasn’t sick and had no diagnosis for the illness. Our family was a victim of this. When we started our own business 15 years ago, we got thrown into the brutal individual market in Alabama. My husband had a family history of colon cancer, so he was diligent about getting regular screenings. Humana agreed to sell us a policy, but refused to cover him for any sort of cancer. Ever. That’s because he had a family history and had “sought treatment” for cancer. Except that he didn’t seek treatment: he got regular screenings to make sure he was healthy!
Isn’t that just what Mo Brooks thinks people should do? Take responsibility for their own health care? And yet, we were penalized – and Alabama insurance lackeys, I mean regulators, didn’t give a damn.
That’s the Alabama insurance market that Republicans want to bring back.
As to the GOP’s assertion that states are more responsive and trustworthy actors on health care regulation than the federal government, let’s go back a few years and look at Alabama’s individual insurance market before Obamacare:
- Limited required benefits: Alabama required insurers to cover 19 benefits – compared to a nationwide average of 38 benefits. Treatment not required by Alabama included: cancer screenings, chemotherapy, and maternity coverage.
- Higher prices: We paid more for less. There were no limits on or oversight over premium costs.
- 5-year lookback: Insurers could scrutinize your health history for 60 months in the past to uncover pre-existing conditions.
- Permanent blocks on care: Forget waiting periods! Any identified pre-existing conditions meant that you could never get coverage for that condition.
- Rescission: If you got sick while covered, the insurance company could go back through your health history and look for a reason to retroactively call it a pre-existing condition. The company then had the option of canceling your policy or just refusing to pay for the coverage you needed. At no point did it have to refund premiums you paid in good faith. Read some rescission horror stories.
- No right of appeal. While other states had procedures in place so that consumers could appeal denials or rescissions, Alabama didn’t give you any opportunity to appeal coverage cancellations. Sure, you could write the company a letter, but they didn’t even have to answer.
Pre-Obamacare, insurers did this routinely. They weren’t even embarrassed to admit it, telling Congress in 2009 that they had no plans to halt rescissions:
Executives of three of the nation’s largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.
The committee’s investigation found that WellPoint’s Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies.
One employee, for instance, received a perfect 5 for “exceptional performance” on an evaluation that noted the employee’s role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.
This is the world that House Republicans and our entire GOP delegation wants to bring back – all in the name of “freedom” and “choice.”
It’s a system that gives all the power to insurers because profits “Trump” people every time.
If you’re someone covered under employer-provided insurance and planning to jump into the comments and complain about being forced to pay for “free stuff” for other people, remember that uninsured people have been footing the bill for your tax-free employer insurance for years.
Obamacare insurance subsidies are expected to cost $1 trillion over ten years. An estimated 160 million people have employer-provided coverage, and tax subsidies for employer-provided coverage cost the federal treasury $200 billion in 2007.
Multiply that $200 billion by 10 years and the federal treasury takes a $2 trillion hit – twice the cost of ACA premium subsidies.