Pre-existing Conditions Canard

Right From the Start

Canard, red-herring, fabrication, hoax, exaggeration, and the list could go on and on regarding pre-existing conditions being debated as a part of the effort to repeal and replace the Affordable Care Act (Obamacare).  To listen to the Democrats and the mainstream media you would assume 1) that the number of people with pre-existing conditions is legion, 2) that all of them will die if Obamacare is repealed, 3) that the only recourse is to force the insurance companies providing coverage to the individual market to include pre-existing conditions, and 4) that those forced to purchase in the individual market must pay a premium (in most cases an extreme premium) to fund that acceptance of pre-existing conditions in those policies.  None of these assertions are true – unless, of course, you believe that the government is the best solution for every problem.

First, prior to Obamacare, approximately 15.7% of the population were uninsured.  After the first year of implementation that percentage dropped to 15.4%. By 2015 that rate had fallen to 9.1%.  Of the nearly 20 million people who gained coverage under Obamacare, 14.5 million grew out of the expansion of Medicaid.  Nearly half of the remaining “growth” came from people who lost pervious coverage from existing carriers who were forced out by implementation of Obamacare.  The staggering costs of Obamacare, including government subsidies and increases in premium costs resulted in improving insurance coverage by a mere six percent.

Second, pre-existing conditions are already included by employer supplied insurance plans, Medicare, Medicaid and military insurance coverage.  The United States Census Bureau indicated that 55.5% of the insured population was covered by employer supplied healthcare insurance, 19.6% by Medicaid, 16.3% by Medicare and 4.7 % by military insurance coverage – that’s 96.1%.  That means that less than 4% of those insureds purchase from the individual insured coverage.  That 4% constitutes the group that is at risk of being denied coverage for pre-existing condition.  Not the whole 4% but the estimated 20% of the 4% that might actually have disqualifying pre-existing conditions.  It is also important to note that “pre-existing conditions” do not necessarily assume permanent or extended care.  Pregnancy is considered a “pre-existing condition” despite the fact that it will conclude within nine months and that a child born of the pregnancy is then covered by the healthcare insurance policy.  Injuries due to accidents or assault are considered “pre-existing” conditions despite the fact that most people recover from both.  While pre-existing condition do exist, the number of people at risk are not legion, not even massive, they are a small percentage of a small percentage.

The hyper-hysteria promoted by liberals like Democrat presidential aspirant and Senator, Bernie Sanders (Socialist-VT), that thousands will die as a result of the repeal of Obamacare is also bogus.  Other dingbats on the left like House Minority Leader Nancy Pelosi (D-CA). Gov. Terry McAuliffe (D-VA) and Rep. Debbie Dingell (D-MI) have chimed in that people will die.  And it has been repeated often enough by the mainstream media that the unwitting may actually believe it.  The Chicago Tribune opined that nearly 44,000 people will die annually as a result of the repeal of Obamacare.  Likewise, the Washington Post and the late night “comedians” are universal in their conclusions that thousands will die.

Look, people died prior to the adoption of Obamacare, people died after the adoption of Obamacare and people will die after the repeal of Obamacare. That is a statistical certainty that exists without any tangible evidence of cause and effect. According to an October 19, 2016 article in Bloomberg there are still 27 million people who remain uninsured despite Obamacare.  Nearly half of those remained uninsured because the cost of insurance under Obamacare was too expensive – particularly among those under forty who did not need nor want the coverage demanded of Obamacare.  Among those are people with pre-existing conditions, people with chronic or severe medical needs, and people who, in fact, are dying.  Yet not a word is said by the Democrats or the mainstream media about those sick and dying because of the shortcomings of Obamacare.

These claims are emotional rather than factual but it tugs at the heartstrings of America.  I do not want to trivialize the difficulty of people with pre-existing conditions.  Yet, virtually everyone with a pre-existing condition can get healthcare – through Medicaid, Medicare, the Emergency Medical Treatment and Active Labor Act (EMTALA) which bars emergency rooms from requiring proof of insurance before rendering care, and private charities.  As often as not the access to healthcare is determined by the proximity of healthcare providers and the availability of healthcare insurance has no impact on that.

These claims are emotional and that is precisely why the Democrats and the mainstream media have seized upon them in an attempt to derail the repeal and replacement of Obamacare.  In short, they have no response to the collapse of their hero’s singular, signature legislative achievement and like so many liberal ideas that are strong on emotion and weak on facts, this has become their habitual response.

There are a plethora of substantive issues that should be debated regarding the Republicans proposal.  For example, it does virtually nothing to address the underlying problems of the rising cost of healthcare – not healthcare insurance, but healthcare itself – such as the burgeoning costs of drugs at the end of their patent lives, the extension of patent lives because new treatments are found using old drugs, the intra-referral system between medical professionals that does little for diagnosis and less for treatment but allows multiple providers to charge against insurance programs, and the barriers to nationwide buying programs such as suggested by Sen. Rand Paul (R-TN).  But these issues – critical as they are – cannot be reduced to chants, posters or sound bites and, therefore, elude Democrats.

While the Democrats are hopeful that the adoption of a plan by Republicans will have the same devastating impact on them that Obamacare had on Democrats; however, the probability is that their opposition will collapse the effort to repeal and replace Obamacare and they will be left standing in the ruins of the collapsing Obamacare system.  Sometimes you get exactly what you deserve.
  • Bob Clark

    ObamaCare is actually the large surge in Medicaid. The healthcare Exchanges were so burdened with federal mandates layered in with state mandates, they are destined to fail. Once you hand out a new slough of bennies it is very difficult to remove them, and instead, they are allowed to continue on as a drag to economic vitality; as people have one more reason to reduce their own efforts at producing economic value. Then there are the U.S Senate rules which make fully replacing ObamaCare impossible (needing 60 votes, or 8 or more Dems jumping ship). Ideally, the way to reform Medicaid would be to offer vouchers or tax credits to those on it for seeking out lower cost solutions to their ailments.

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  • Myke

    No one is talking about the business model of the AMA that has removed, through the use of proprietary coding, any measure of cost competition in the medical profession. Insurance is not the driver of cost, but a vehicle for the means of cost sharing. The driver of cost is the disassociation between what a procedure actually costs, and the asking price for the services rendered.

    The AMA is a monopolistic organization that establishes medical procedures, and the prices to be charged for those same procedures in a two-tier manner, through the use of a 50 member board dominated by medical specialists. Their copyrighted catalog is used to retain total control over the information on the procedures, and what should be charged, and is used by insurance companies to provide billing. But, because of the private nature of the organization, no information is available on how the information is derived, and through the use of the courts is protected from public scrutiny. Hence, the removal of price as a competitive tool in the marketplace. No one in your doctor’s office knows what the cost of the very services they are rendering is. Or, what the charges will be.

    Adding further insult to injury, Medicaid uses this information in a quasi private/public relationship to establish what it is willing to reimburse providers. This relationship is thought to be illegal by some, and results in the disconnect between the two systems. Until this business model is disrupted, no amount of meddling with the insurance industry will add price competition to an industry that has grown to a proportion similar to that of the oil industry of the pre-oil embargo 1970’s.

    Access to, and Control of information are basic tenants of economic competition. Call your representative and request that price transparency be reintroduced to the medical industry, and not just through the insurance industry.

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  • john.fairplay

    I’m pretty sure that health insurance companies can figure out a way to profitably offer policies to people with pre-existing conditions. There’s no reason those people shouldn’t have a choice of coverage or not (“not” of course is disallowed under ObamaCare). They should bear the full freight of their personal health insurance needs and shouldn’t complain about doing so. After all, if you have a series of car accidents, your insurance rates are higher than if you’ve never had an accident.

  • Jack Lord God

    Americans have learned two things from the ACA experiment:

    1) Americans want pre existing conditions covered in any replacement of ACA that might come up. This shows up in every poll and in any discussion of the matter.

    2) Americans want 1, but do not want to pay for it. Virtually every complaint about the ACA is with regard to pricing. Prices for insurance naturally soared after no one could be turned away. This was obvious and predicted in advance of ACA passage. People simply don’t like subsidizing other people. They like the idea of telling others to do so, but not when the consequences affect their pocketbook directly. This subsidizing is exactly what is happening with the soaring rates.

    So what do you do about it? To continue to complain about insurance companies being the problem is to admit lack of any real cognitive ability. In any market where the populace is required to buy the product, and where prices in that market are rising rapidly, you would expect to see two things happen with suppliers in that market – massive profits, and massive new suppliers entering the market to cash in. In addition one would expect to see insurance company stocks soar as people rushed to buy stocks in a market with forced buyers and rapidly escalating prices.

    However the exact opposite is happening. Insurance companies are leaving the market in droves. In many areas only one provider remains, in some areas none. This completely disproves the argument that greedy insurance companies are responsible for rising prices. Companies simply don’t leave markets that are wildly profitable.

    This implies, and fairly convincingly, that the argument that insurance company profits are the reason for the expense of American health care is ill founded.

    It’s an interesting situation, and one that aligns precisely with ACA opponents predictions at the outset. The insurance company death spiral was predicted. It now is in such full view that even the staunchest ACA proponent admits the exchanges are in collapse. Personally I don’t like constantly having to pay for these screw ups (I am in the individual insurance market).. However it is fascinating to see them happen with such endless congruence. .

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