When it comes to pre-existing conditions, divided we fall
Now that the
Congressional Budget Office (CBO) has released its analysis of the House healthcare bill, the Senate is reportedly
starting from scratchon its own version. Here’s a suggestion from one health insurance CEO for where they should begin: Reject the idea that health insurers could, under any circumstances, charge more for individuals with pre-existing medical conditions.
Our nation is already struggling with enough division — economic, racial, geographic, and political. It would be both tragic and unnecessary to create a new divide between those who are seriously ill and those who are healthy. Rather than trying to fix the pre-existing condition provisions in the House bill, the Senate should take them off the table, permanently.
Anyone who tried to buy individual health insurance before the Affordable Care Act (ACA) remembers the problem. In most states, if you had a pre-existing condition, you could either be denied coverage or forced to wait for months or years before treatment for the condition was covered. You could also be charged a much higher premium.
So, for many people with serious medical conditions, the anxiety of illness was compounded by financial insecurity. Some were forced to sacrifice family savings or run up large debts; others went without needed care.
Since 2010, the ACA has guaranteed that individuals with pre-existing conditions are eligible for the same coverage as everyone else, at the same cost. My state, Massachusetts, is one of seven that had pre-existing condition protections in place even before the ACA became law. It’s arguably one of the ACA’s most popular provisions, and it has maintained broad, bipartisan support. Unfortunately, a last-minute addition to the House-passed American Health Care Act (AHCA) reopens the issue by giving states the option of once again allowing insurers to charge higher premiums for individuals with pre-existing medical conditions. The CBO found that, in states choosing this option,
“less healthy people would face extremely high premiums.” The Senate should settle the matter by rejecting this provision as unnecessary and divisive.
Rather than allowing pre-existing medical conditions to again divide us, let’s acknowledge that illness is actually a great equalizer. From birth to death, no one is immune from the risks of disabling injury or chronic illness. It may befall you, your spouse, your parent, or your child.
If it’s not your family, it’s your coworker, your friend, or your neighbor. That’s one of the reasons individuals and families so easily bond with people facing similar medical challenges, regardless of their political beliefs or economic background, and it’s why tens of millions of people join together to donate and raise money for efforts to find cures and support treatment. We’re all in it together.
A return to charging higher premiums for people with pre-existing conditions would also reinforce the mistaken notion that serious illness stems largely from personal choice. Most illness and disability is due not to choice but to bad luck and bad circumstances — the accidents of birth and life, including genes, economic and social factors, workplace conditions, and exposure to infection and toxins.
Even for those illnesses where personal choice can matter, chance still plays a big role. Some people manage to avoid serious illness and live long lives despite unhealthy habits and poor choices, while others who lead much healthier lifestyles may not be nearly as fortunate.
A fair, stable health insurance system requires an adequate number of both sick and healthy people who contribute to the pool of funds available to pay medical claims. That’s not the case in some of the state marketplaces where individuals can buy coverage — too few healthy, lower-cost people have enrolled to balance the higher costs of their sicker population.
So it’s perfectly legitimate for Congress to consider better ways to encourage healthy individuals to buy and maintain insurance and there are a variety of available mechanisms to achieve this goal. What Congress must not and need not do, however, is return us to the days when insurers could increase premiums for individuals with pre-existing conditions. We should take this option out of the policy conversation and out of our healthcare system for good.
There are other substantial problems with the House bill in addition to the pre-existing conditions provision, including deep cuts to Medicaid funding, the uncoupling of individual health insurance tax credits from personal income and regional medical costs, and a change in how much more older people could be charged for coverage.
The net effect of these provisions would be to make health insurance unaffordable for many of the older and poorer Americans who are currently insured under the ACA. Bipartisan solutions to these problems should be within reach and may emerge in the Senate. But before we tackle these problems, we should agree that, whether we are healthy or sick, we are all created equal, and our health insurance system should reflect this American principle.
Andrew Dreyfus is President and Chief Executive Officer for Blue Cross Blue Shield of Massachusetts, one of the largest independent, not-for-profit Blue Cross Blue Shield plans in the country.
