The human impact of the Republicans’ dismantling the Affordable Care Act (“Obamacare”) and replacing it with their own abomination has tended to focus on its cost in terms of premiums, or the number of people who will lose their health insurance as a result of the Republican plan (23 million in the next decade, according to the Congressional Budget Office). Less remarked on are the actual provisions of the bill, what they mean and don’t mean for millions of Americans in terms of actually receiving medical treatment at all, specifically those with “pre-existing" health conditions.
Elizabeth Rosenthal is the Editor in Chief of Kaiser Health News. A former New York Times correspondent, she is a graduate of Stanford University and Harvard Medical School. She joined the Kaiser Health Network in September 2016. In an Op-Ed published yesterday in the Times, she points out one of the less discussed aspects of the Republican “plan”:
The Republican health care plan recently passed by the House would hollow out one of the most popular provisions of the Affordable Care Act: a prohibition on charging higher prices to people with pre-existing medical conditions. States, under the plan, could waive that rule, provided they offer publicly funded alternatives for coverage.
The Republican bill allots $100 billion for “alternative programs” for the states who “waive” the rule requiring coverage of those with pre-existing health problems (30% of all adults under 65, according to a Kaiser Study). While the CBO has already concluded that would be woefully insufficient (considering the fact that individual medical bills for serious medical problems can easily run into the millions), there is a much more fundamental problem—nowhere in the Bill is there any restriction on what an insurer may deem as a “pre-existing condition:”
Before the Affordable Care Act (“Obamacare”) , profit-taking insurers had lowered the bar for what was considered a pre-existing condition to include nearly very malady, making it difficult for many healthy patients to get affordable insurance.
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“Insurers each drew a line within the sand in which was invisible for conditions they didn’t want to cover,” said Jean P. Hall, the director of the Institute for Health along with Disability Policy Studies at the University of Kansas. “We didn’t even know where in which line was because the idea was considered proprietary information.”
Before ”Obamacare,” the denial of coverage on this basis had become a time-honored, routine practice of the four largest for-profit insurers in this country, according to a 2010 study conducted by the House Committee on Energy and Commerce, a fact which many Americans were made painfully aware of that well before the Congress decided to check. Rosenthal cites stories of people denied coverage for once taking Lexapro, an anti-depressant, or having a benign and resolved skin cancer, or a slightly abnormal Pap smear. This is the simple reality of our grotesquely profit-centered health care system. One company studied by the same House Committee specifically recommended the “improvement” of “pre-existing exclusion processes” for the purposes of maximizing the insurer’s profits.
In fact, just as the Affordable Care Act was being debated in the Congress, denials of claims based on “pre-existing conditions” had risen 50% (between 2007 and 2009). Profit—not health care-- was clearly the watchword for the insurance companies, and it was on the march. Meanwhile, affordable health options for ordinary Americans were rapidly disappearing, as insurers began to reject people based on such criteria as their weight alone, or the fact that they may have been susceptible to common or seasonal maladies such as “hay fever.” These people were in turn tossed to the states' underfunded high-risk pools.
The Affordable Care Act (“Obamacare”) put a stop to this insanity, by requiring insurers to provide coverage to those with pre-existing conditions, however they “defined” them. The Republican plan allows the issue to be decided by the states:
Insurers would be able to charge more to people with gaps in their insurance coverage. And a recent change, the MacArthur amendment, would allow states to waive some of the Obamacare requirements, including one that's relevant to pre-existing conditions. States that are granted such a waiver would allow insurers to set premiums based on health status -- current health, health history and other risk factors -- or in other words, pre-existing conditions.
Rosenthal points out that the practical effect of this omission is that insurers will continue to find anything plausible in peoples’ health histories to justify denial of coverage. This will in turn prompt people to forego necessary medical treatment for serious illnesses, out of fear that they will then become uninsurable. She uses cancer screening as an example:
With the possibility of a poorly financed high-risk pool looming, a rational person might avoid a colonoscopy. A polyp removal might prevent cancer however could mean paying higher insurance rates, because patients who get polyps are at risk for developing more polyps, which can be precursors to cancer.
The way the Republican plan is currently written, only those in perfect health would not be susceptible to “reclassification” as a “risk” by some heartless bean-counting insurance company:
There is no limit to what physiological imperfections could become an effective death sentence. And physiologically speaking, nobody is perfect. Each of us is vulnerable to the unchecked exclusionary power that the health care bill would restore to the health insurance sector — a power that insurance providers have wielded before and used to devastating effect.
As a practical matter, none of us in the final analysis would be able to escape being shunted into an expensive high-risk pool, simply because, like it or not:
We all have — or will have — some kind of a problem in our medical history.