With the passage of the House health care repeal act, reform advocates are gearing up for a new sales campaign to try to convince the American public that it is, indeed, a good deal. At the heart of the argument for health care reform is the provision that would prevent insurers from denying coverage for people with pre-existing conditions.
Although this provision is not to take effect for adults until 2014, it has already been implemented for children. Reform advocates insist that, if the bill were to be repealed, as many as 100 million Americans could potentially be denied coverage due to pre-existing conditions.
Pre-existing Conditions: The Facts
Reform opponents argue back that, under present laws, most people cannot be denied coverage for a pre-existing condition, and that only about 9% of the population (generally those who are not covered by employer plans) are potentially affected by coverage denial. Currently, 90% of the population is covered by employer-based insurance plans, which have established guidelines for pre-existing conditions that prevent coverage denial for anyone who has maintained coverage prior to and through their employment.
Opponents of reform insist that, while there needs to be some reform as it relates to pre-existing conditions, it doesn’t require a massive 2,733 page bill and 159 new bureaucracies to address an issue that affects such a small slice of the population. While reform advocates are trying to paint the opponents as compassion-less for their willingness to expose tens of millions of Americans to possible denial, the opponents suggest that the reform law creates a self-fulfilling prophecy because it will have the effect of driving millions of people out of employer-based plans into the individual insurance market where the real problem exists.
Are Health Reform Advocates, or Opponents Telling the Truth?
The real truth probably lies somewhere in between. No one can deny that the potential problem of pre-existing conditions and the possibility that millions could be denied access. At the same time, there is little evidence that it is, presently, the monumental problem that reform advocates would have us believe. Reform opponents point to the dismal response to the high-risk pools that were instituted last year with less than 9,000 people enrolling compared to the tens of thousands that were projected by Health and Human Services.
As issue is whether a government mandated program that would force insurance companies to cover all pre-existing conditions, and even those who don’t seek coverage until forced to by a new medical condition, would actually skew the risk pool leading to much heavier subsidies through increased premium payments for the healthy insured. Opponents see this as bending the cost curve up, not down.
Health Insurance Changes: Getting on the Same Page
Reformers and opponents alike agree that the pre-existing condition element is a key ingredient for any meaningful reform, but, where reformers originally touted the bill primarily as a means to bend the cost curve, opponents point out that the bill does very little to cut costs and is primarily focused on coverage.
Whatever happens in the political arena as far as repeal or dismantling of health care reform, the growing consensus is that something has to be done to protect the small portion of people who face some sort of discrimination based on pre-existing conditions. The current law, which appears to discourage the growth of employer-based plans, and has all but eliminated the incentive for insurers to offer HSA or high deductible insurance plans, does more to exacerbate the problem than to cut to the heart of it. Issues such as pre-existing condition coverage and coverage for uninsured individuals are better addressed in more targeted and cost-effective ways that allow for some solution customization on a regional or state level.
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