Care 411


The Plight of Pre-Existing Conditions, And Possible Reform

admin November 8, 2018

At the beginning of 2014, a provision in the affordable care act will make it illegal for insurance providers to decline applicants with pre-existing conditions, or to charge them exorbitantly more than their healthier counterparts.  This is welcome news for patients suffering from such conditions as autoimmune disorders, diabetes, blood disorders, neurological disorders, and mental illness, among others.  As things currently stand, patients suffering from such conditions are commonly considered too “high risk” for insurers to take on.  Without employer-provided insurance, patients with pre-existing conditions have few promising options to fall back on.  While the upcoming ban on insurance exclusion and prejudice promises to provide a tremendous relief to patients, there are still opponents who argue that it is an unwise idea.

As things currently stand, uninsured patients with pre-existing conditions have a list of options ranging from middling to grim: They can obtain insurance through an employer, but not every employer offers health benefits.  In the midst of the current unemployment crisis, many are forced to take whatever work is available.  Even if one is lucky enough to find work at a livable wage in decent conditions, there’s no guarantee that their employer will provide health coverage.  If a patient with a pre-existing condition can not find work through an employer that offers coverage, or can not find work at all, they must try to find insurance on their own.  However, most carriers in the United States won’t accept patients with pre-existing conditions, and the few that do accept them charge exorbitant premiums well out of the price range of the average, middle-class, working American.  If the patient can not find a carrier to accept them, or afford the quoted premium, another option is to join a high risk pool.  However, this is also tremendously expensive.  When faced with these options, it is not surprising that some are forced financially to go without insurance and to hope for the best.

As discussed in yesterday’s post, some may argue quite reasonably that those needing extra care should pay more.  They may even argue that banning insurance exclusion would force carriers to raise premiums for all patients, sick or healthy.  However, uninsured patients forced by illness or injury to visit the emergency room (sometimes termed “free riders”) have been known to raise health costs across the board at a significant margin above the projected cost of insuring those with pre-existing conditions.  While denying them coverage may seem financially savvy, it carries a high risk of driving them to the emergency room when they do need care, resulting in a higher cost than would have been incurred by insuring them in the first place.  What’s more, an insurance carrier’s projected cost of care for a condition can often be inaccurate.  It is not uncommon for a pre-existing condition sufferer with his/her symptoms well under control to be turned away, regardless of how inexpensive their treatment might actually be.

This led a blogger on to hypothesize an alternate, conservative-backed plan that would allow patients with pre-existing conditions to purchase an alternate type of coverage that would allow them to “earn” healthcare access over time.  This is an interesting idea with room for potential, and certainly capitalist-friendly in many respects.  However, without more details, potential problems come to light.  Would there be a cost discrepancy?  Would the healthcare line afforded to these patients be similar to a credit line?  What if the patient experienced an uncontrollable or unavoidable flair-up of their symptoms?  How would that affect the process of “earning” protection? Would they be penalized for health-related events beyond their control?

There are others who state that the percentage of Americans with pre-existing conditions is so small in relation to the rest of the country, that it is not an issue worth any substantial investment of money or policy change.  That those few will simply have to be self-reliant and resourceful.  However, when one suffers from Crohn’s Disease, MS, Von Willebrand, or another such disorder, and can not get insurance, it certainly doesn’t feel like a small or insignificant problem, especially when resources are so very limited.  It raises a crucial question: Is a system that fails to protect hard-working, law-abiding tax payers and their family members who are willing to buy insurance, even there are only a few of them, truly a system that works?

It does seem that some type of reform is necessary so that those who are willing to work and pay a fair price for coverage aren’t turned away or charged astronomically due to a pre-existing condition.  To accept otherwise would be to accept discrimination.  To be free of a pre-existing condition does not necessarily make one a more responsible person or more of an asset to their community than a person who does suffers from one: It just makes one luckier.

But if this flaw in the system is to be fixed, which path is best?  The Obamacare solution seems simple enough, but there are concerns about increased costs for all, a possibility of health rationing, and other problems that may arise as the kinks get ironed out.  While some are willing to put up with hiccups in the system for the sake of affordable coverage for all, some are violently opposed to what they perceive as an overreach of government power that will cost them extra money as well as quality of care.  What solution would you recommend to aid patients with such conditions?  Do you think any solution is needed at all? Are you aware of any resources such patients may rely on for extra help as this issue develops, and hopefully, resolves?  Please share your input in our comments.

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