Wallie Morris: Protect individuals with pre-existing conditions
May 17, 2017
What do asthma, depression, an abnormal pap smear, cancer, obesity and ADHD have in common? Under the current form of the American Health Care Act, they can be considered pre-existing conditions. And under the AHCA, pre-existing conditions can result in denial of coverage, significantly higher premiums or a coverage rider excluding coverage for that particular condition.
I personally know individuals who, prior to Obamacare, were denied health insurance because of the following pre-existing conditions: breast cancer, Crohn's disease and situational depression following the death of a child. I have seen friends and family suffer severe illness and go into medical debt because health insurance was not affordable or available.
According to a recent analysis conducted by the Kaiser Family Foundation, "an estimated 52 million adults have pre-existing conditions that could make them uninsurable" without the insurance regulations of Obamacare.
The MacArthur Amendment of the AHCA allows states to apply for a waiver on the community rating. The community rating limits the amount of money health insurance companies can charge because of age, health and gender.
House GOP leaders say the amendment prevents insurers from denying coverage to people with pre-existing conditions. However, without community rating, health plans are free to charge those people any amount.
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Plans may be available, but price gouging will render them unaffordable. And what, truly, is the difference between being unable to afford coverage and being denied coverage?
The AHCA's answer to that question: additional state funding to establish high risk pools that cover patients who are underwritten, denied coverage or unable to afford coverage as the result of that underwriting. However, the Center for American Progress, a non-partisan policy institute, estimates the additional funding will leave these pools underfunded by at least $200 billion.
That means approximately 800,000 people with high-cost health conditions would be left without affordable health insurance. And, historically high risk pools were ineffective in reducing costs and providing appropriate coverage.
You might be thinking: "Who cares? I have coverage through my employer. I'm healthy. This doesn't affect me." Wrong!
Obamacare banned lifetime and annual dollar limits, which applied to the 10 essential health benefits. The MacArthur Amendment also allows states to eliminate the requirement that insurance plans cover the essential health benefits. Should any state decide to waive all or some of these benefits, large employer plans will be allowed to deny or cap coverage.
What if you lose your job? Can you afford COBRA? If you have a pre-existing condition, your coverage can only lapse for two months before you are labeled high risk.
"But I'm healthy," you say. According to the Centers for Medicaid and Medicare Services, 15 to 30 percent of healthy individuals will develop a health condition needing health care in the next eight years. You might find yourself sick without employer coverage or with a limit on what your insurance will pay.
Now is the time to educate yourself on health care policy. It will impact you. Now is the time for action.
The AHCA is about cutting taxes for the wealthy and supporting big insurance companies on the backs of those who are sick. Consider what legislation, like Medicare for all with universal coverage, will mean for public health in our country.
Demand from Senators Gardner and Bennett that any legislation reaching the Senate floor provides all of us with affordable insurance, especially when we need it the most.