This week, John Goodman published a Wall Street Journal op-ed, here, concerned with the issue of preexisting conditions. His essay prompts me to post the below comments, which are notes from a short presentation. I’m afraid my material is pretty basic for this audience.
The most popular aspects of health reform are those which protect Americans with preexisting conditions. Governor Romney is under pressure to explain how he would address these matters given his pledge to repeal health reform. He recently announced that he would support some sort of open enrollment period, when everyone can buy insurance without penalty for preexisting conditions. People who remain continuously insured would then enjoy basic protections similar to those already provided within the large-employer market through the 1996 HIPAA law. The Romney campaign has not, to my knowledge, provided further details.
This plan is better than nothing. Ironically, the continuous coverage provision is a de facto individual mandate. People who stay covered will enjoy important protections. Others won’t.
Unfortunately, it is a small step that does not address the core issues. Right now, about four million Americans are both uninsured and have been diagnosed with serious conditions: Diabetes, cancer, heart attack, stroke, emphysema, and the like. Millions of other people have other preexisting conditions that create health problems and that foster discrimination within the small-group and individual insurance markets. How do we deal with this problem?
A good starting point is to ask: Why are these four million people uninsured in the first place? One obvious answer is that they have trouble paying for coverage. These are people with modest incomes, and insurance is quite costly. This particular group may be excluded from the insurance market. Yet many may also have been uncovered before they became sick. Insurance is expensive. People become stuck between jobs. People ignore health problems and take stupid chances. When fifty million people lack health insurance coverage, some fraction are going to become very sick, and, hence, medically uninsured.
The Affordable Care Act deals with these problems through an individual mandate, insurer nondiscrimination provisions, and a combination of Medicaid expansion and health insurance exchange subsidies to ensure that people have access to affordable coverage. Each of these pillars is required elements of health reform. Repealing health reform’s Medicaid expansion and the exchange subsidies will increase the number of uninsured by roughly 30 million people relative to current law.
ACA also includes provisions make sure that health insurance actually protects people with costly conditions. Addressing commonsense notion of underinsurance matters for these issues, too.
These provisions include provisions to limit patient out-of-pocket payments, and to phase out annual and lifetime dollar-caps on what insurers will actually cover in cases of costly illness or injury. There was just a tragic case in south Chicago, of a high school football star named Rocky Clark who was rendered quadriplegic on the gridiron. He required intensive nursing care and other services. He hit his lifetime cap. His mother cared for him as best she could. He died tragically, leaving his mother with a stack of punishing medical bills.
ACA also guarantees an essential health benefit package, so that insurance actually covers a reasonable standard of care. Insurance must be affordable. It can’t cover everything. Difficult decisions must be made. Insurance does need to cover reasonable treatments. An Institute of Medicine committee struck a reasonable compromise, recommending a standard based on benefit packages similar to that covered by a typical small employer.
The Romney campaign hasn’t provided the fine-print–or even the medium or large print–regarding such matters. Based on what’s been revealed so far, it won’t do the job for people with preexisting conditions.
