If you have a history of hypertension, diabetes, rheumatoid arthritis, breast or prostate cancer, lumbar stenosis, treated grand-mal seizures or any of tens of thousands of conditions in the spectrum of human disease, you have a pre-existing condition. As a member of the human race, you either have or will eventually have one or multiple pre-existing conditions in your life. Not one medical condition or diagnosis in the vast universe of human pathology, whether minor or life-threatening, is mythical. As an anesthesiologist retired from a forty-year clinical career, virtually all of my patients had one or multiple “pre-existing” conditions. The co-morbidities in a given patient often have an important or critical impact on the management of the anesthetic. Why have I entitled this essay as The “Myth” of Pre-existing Conditions?
Let us shift our focus to the political and insurance implications of “Pre-Existing Conditions”. This focus is quite different from the medical reality of 320 million Americans’ true health care profiles. A different story always emerges when actual facts are considered in any political story, especially during an election season immersed in malignant partisan behavior. Consider the following about the history of “pre-existing conditions” since the 1990s to the present day.
- The incessant cry of Americans being bankrupted by a “pre-existing condition” was used in the run-up to the March, 2010 passage of the Affordable Care Act by a one-party majority legislative juggernaut with complete absence of any bipartisanship. Its purpose was to create fear and anxiety in the citizenry.
- The real story of “pre-existing conditions” was then and is now that the vast majority of Americans, a large percentage of whom have existing medical conditions, are insured through employer-provided insurance (fully or in part), Medicare, Medicaid, VA coverage, the Indian Health Service and other insurance platforms that accept all patients with or without pre-existing conditions.
- The problems of pre-existing conditions pertained to less than 1% of the population in 2009 and had been effectively dealt with by state-run, tax-subsidized high-risk pools in 37 states. The increasing movement toward state-subsidized, high-risk insurance plans for the very small (0.67%) segment of the American population trapped without insurance from job loss or a decision not to insure before illness occurred was growing, effective and appropriate for a society caring for its most needy. Obamacare ended this abruptly.
- The 1996 HIPAA (Health Insurance Portability and Accountability Act) legislation was directed at protecting the maintenance of health insurance for Americans as well as issues surrounding “confidentiality” of medical information. Insurance companies were forbidden by statute to cancel insurance for a new condition or charging exorbitant premiums for clients continually insured prior to a new, now “pre-existing condition”.
- The Affordable Care Act, a.k.a. Obamacare, raised insurance costs for American families and limited insurance options to the extreme. If you have an ACA “protected” pre-existing condition and are insured in the market outside of Medicare or Medicaid, premiums are more than 200% of pre-ACA costs and individual and family deductibles have risen to many thousands of dollars. If you or a family member have an expensive medical condition that was previously (pre-Obamacare) well covered by private health insurance with affordable premiums and deductibles, the annual cost of ACA insurance premiums and deductibles may now reach $20,000 or more before the first dollar of insurance coverage is triggered. A family with an annual income of $60,000 or more and ineligible for Obamacare subsidies is in a financial nightmare. This is not protection of “pre-existing conditions”, the rallying cry and fear mongering that was used to force the ACA into existence by a one-party vote.
This constant “Pre-Existing Condition” cry by the Democrat party and every Democrat candidate in the 2018 mid-terms and in the current election is indeed a political myth. Despite the GOP response always being to “Protect Pre-Existing Conditions”, the mythical perversion of a real medical and insurance coverage concern for a very small segment of the American population is a disgraceful use of language as a propaganda tool.
Reform of health care costs is the overwhelming issue for our economy and for all Americans relating to their medical care and access to the health care system. Unless voters are armed with the facts about health insurance and the reality of actual coverage for pre-existing conditions, their votes may be cast for candidates and a party seeking to achieve the century-long goal of a single-payer, government health care system primarily to advance political power and to create dependence. The majority of Americans wisely know or sense that a government controlled, single-payer health care system would deprive us of high-quality medical care by mandated rationing of resources and diminished future advances in medical care we expect and deserve.