May 1, 2017

Pre-Existing Conditions: How the New Proposed Healthcare Plan Could Deny You Coverage

Pre-Existing Conditions: How the New Proposed Healthcare Plan Could Deny You Coverage

Congressional Republicans are dead-set on repealing and replacing the Affordable Care Act, seemingly without regard for making improvements to the system. The President’s promise was more people covered with better care at less cost. That is not what the new GOP proposal would provide.

The main criteria for GOP proposals seems to be to make plans cheaper by eliminating access to care for millions of Americans. The latest iteration of the Republican healthcare proposal is to remove protections for “pre-existing conditions” from health insurance policies. This is the most disastrous of the Republican proposals to date.

The Department of Health and Human Services defines pre-existing conditions as “a health problem you had before the date that new health coverage starts.” Since January 2014, insurance companies have been prohibited from refusing coverage to individuals based on pre-existing conditions.

Pre-existing conditions are common. Anyone who has had cancer (even if now cancer-free) or has a chronic condition such as diabetes or heart disease has a “pre-existing” condition. This includes problems from childhood, including childhood cancers and Type 1 diabetes. Other pre-existing conditions include obesity, which means that if this healthcare plan was passed, right away more than 35% of Americans would be at risk of losing their healthcare coverage for being obese.

One loses their coverage by having a “lapse” in coverage. Let’s continue with the obesity example. If you are obese and your child, spouse, or parent is ill and you have to quit your job to care for them, you will lose your healthcare coverage through your employer. After your COBRA benefits run out, usually after 18 months, you will be unable to purchase insurance except through a “high risk pool.” High risk pools, in states that have them, offer minimal coverage at extremely high rates. However, if you can’t afford this coverage or you choose not to join the high risk pool, even if you later go back to work and are put back on employer funded insurance, the insurer will never have to pay for anything related to your “pre-existing” condition. Read that as you’ll have to fight to get anything at all covered.

Whom does this affect?

  • Anyone overweight enough not to fit insurers’ guidelines – including those who don’t quite reach the level of clinical obesity. Roughly forty percent or more of American adults.
  • Anyone who has ever taken a medication for high blood pressure or cholesterol, including those whose problems are well-controlled by these inexpensive medications. This would include nearly half of Americans over the age of 40.
  • The nearly ten percent of Americans who are diabetic.
  • The 41% of Americans who will battle cancer sometime in their lives.
  • Addicts and the mentally ill who are frequently unable to work and may not have medical insurance prior to treatment.
  • Anyone who had a serious childhood illness (epilepsy, Type 1 diabetes, cancer, etc.) and has a lapse in medical insurance coverage.

While not all of these people will lose their medical coverage, because the key to losing coverage is having a lapse in coverage, all of them are at risk. That’s well over half the nation.

Is the Affordable Care Act the best we can do? Not at all. There is ample research and evidence that American healthcare would be of better quality and more affordable if we went to a single payer system. These single payer systems are not all the same, but do provide better services than the current American system.

A healthcare system that allows as much as half the population to be vulnerable to a loss of coverage, a system that only covers the young and healthy, isn’t a healthcare system in any sense of the word.

What’s the litmus test? Congress exempted themselves from the proposed plan. If the authors thought it was of real quality, wouldn’t they apply it to themselves and their loved ones?

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About Constance Scharff PhD

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