Pre-existing Conditions Explained, Pregnancy Coverage Not Assured

cartoon The current debate in congress about health care would repeal the Affordable Health Care Act (Obamacare) and replace it with Trumpcare which has been heralded as better but cheaper. It’s not! It is certainly not better, although at the expense of the critically ill it will be cheaper for some.

trumpcareThere are several issues involved in this new bill but the one creating the most debate right now is coverage of pre-existing conditions. The sponsors of the bill along with the White House say that coverage of those illnesses will be even better than before. They are wrong and we’ll explain that later. First though let’s explore the term, “Pre-existing Conditions.” Most people don’t even know what they are, yet they support the Republican plan and some of those conditions can strike anyone at any time. So, before we get into the details of why the plan is detrimental to those with long-term medical conditions here’s the Pre-Obamacare list.  ( )
      * AIDS (1.1 million people): The Centers for Disease Control and Prevention (CDC)    warns that one in six are unaware thy have it.

  • alzeimersAlzheimer’s (5 million): This is the most common form of dementia, according to the CDC.
  • Alcoholism (17.6 million): There includes alcohol abuse or dependence. That means 7 million children live in a household where a parent is dependent on alcohol. As a result, half of all adults have a family history of alcoholism. (Source: “Alcohol and Drug Information,” National Council on Alcoholism and Drug Dependence, Inc.)

cancerCancer (1.6 million diagnosed each year): That’s added to the 14.5 million cancer survivors. (Source: “Cancer Facts and Figures,” American Cancer Society.)

Diabetes (20.9 million): According to the CDC.

Drug Addiction/Abuse (20 million): That’s 8 percent of the population age twelve and older who used an illegal drug in the past thirty days. Another 48 million people (20% of the population) use prescription drugs, such as painkillers, sedatives, and stimulants, for non-medical reasons. (Source: “Alcohol and Drug Information,” National Council on Alcoholism and Drug Dependence, Inc.)

Fatty Liver Disease: Most of the 20 million alcohol abusers get it. Another 20 percent of the population have non-alcoholic fatty liver, which can come from diabetes, obesity, high cholesterol, hepatitis, or even malnutrition. It’s when fat cells make up more than 10 percent of your liver. It can lead to cirrhosis and liver disease. (Source: “Fatty Liver Disease,” WebMD.)

Heart Attack (920,000 annually): There are 7.9 heart attackmillion people heart attack survivors. (Source: “Heart Disease Facts,” The Heart Foundation.)

Inflammatory Bowel/Crohn’s Disease: There are 1.3 million sufferers in total. (“Epidemiology of the EBD,” Centers for Disease Control and Prevention.)

Pacemakers: (188,000 a year): (Source: Amy Norton, “More Americans Getting Pacemakers,” Reuters, September 26, 2012. )

Kidney Failure (113,000 annually): More than 20 million people have chronic kidney disease. That includes one-third of all diabetics and 20 percent of those with high blood pressure. (Source: “Kidney Facts and Figures,” Centers for Disease Control and Prevention.)

Rheumatoid Arthritis (1.5 million): That’s in addition to the 26.9 million people with osteoarthritis. (Source: “Rheumatoid Arthritis,” Centers for Disease Control and Prevention.)

Stroke (800,000 people annually): Nearly 130,000 are fatal. (Source: “Stroke Facts,” Centers for Disease Control and Prevention.)

Another 26 percent could be denied coverage for what the insurance company called a pre-existing condition, even though they were healthy. The following were considered pre-existing conditions, even though they weren’t diseases:

intellectual disabilityIntellectual Disability (4.6 million): Defined as an IQ (Intelligence Quotient) of 70 or below. (Source: “Introduction to Intellectual Disabilities,” The ARC.)

Mental Health Counseling: A history of drug, alcohol or mental illness counseling was a reason for denial.

Obesity (Nearly 40 million adults, and 12.7 million children): Those with above-average Body Mass Index score were either denied or charged extra. Annual medical costs for an obese person is $1,429 higher than normal. (Source: “Obesity Facts,” Centers for Disease Control and Prevention. “Prevalence of Childhood and Adult Obesity in the United States, 2011-2012,” Journal of the American Medical Association,” February 26, 2014.)

Pregnancy (6.5 million in 2008 latest data): Womenpregnancy would have to wait a year after getting insurance before they could be covered for pregnancy. (Source: “Estimated Pregnancy Rates and Rates of Pregnancy Outcomes of the United States, 1990-2008,” National Vital Statistics Report, Volume 60, Number 7, June 20, 2012. “Michigan’s High-Risk Pool Program Presumptive Eligibility List of Pre-Existing Conditions.” “Pre-Existing Condition Exclusions,” BlueCross BlueShield of Illinois.)

Rick Mulvaney the President’s Budget Director says the states are better able to handle preexisting conditions in “High-Risk Pools” than is the federal government. Well, that remains to be seen but being as funding them then is mostly up to the states, how can Trump and the Republican leadership in the house say they will be covered? They can’t! States don’t have high-risk pools right now because they didn’t need them under Obamacare. Now they will have to come up with the money to partially fund them.  While there have been discussions of Federal block grants to states there has been no dollar amounts attached until today when an amendment to the Trumpcare bill added $8 billion for pre-existing conditions over five years. By comparison that’s a drop in the bucket. the ACA subsidy was $10 billion a year. Even with limited federal involvement we still have no ideas how much money states will contribute, if anything. That means while those with preexisting conditions might have access to insurance they may not be able to afford it. There are just too many variables with these “high-risk pools” to say without fear of contradiction that people with preexisting conditions will be covered, like the option that states can drop out if they desire.

So, the new Trumpcare bill partially eliminates federal coverage and passes the rest of the responsibility on to the states thereby increasing their cash outlay an expense they didn’t have under Obamacare.

This sounds a whole lot simpler than it is. First, States have limited budgets and unlike the feds are required by law to balance them. During the great recession almost every legislature and Governor slashed spending as much as possible so they are running on a pretty slim revenue stream even now with the economy in better shape. Funding a “High-Risk Pool” is going to be a major expense for them and everyone knows that no politician likes raising taxes, yet that’s what they could face.

One of the reasons we have federal laws is so there is parity among the states. As soon as you turn over control to the states, parity is gone. In this case, Republicans control most of the state legislatures and Governor’s offices. If history is any indicator it is unlikely that those “fiscally responsible” people will make any real effort to fund “High-risk pools. A good reminder is that when the question of slavery was left to the states, many of the Red states did nothing about it and actually started a war to defend it.

In order to better understand “High-Risk Pools,” it is important to have a basic understanding of how insurance works. It is really pretty simple. The more people you can insure, the abler you are to cover those who are really sick. The number of insured is called the risk pool. It covers everybody from those with preexisting conditions to those who almost never get sick. In other words, they spread the risk. If you contract a serious disease that requires a great deal of medical care the large risk pool can keep your costs down because the premiums paid by those who are sick less often will help to cover your expenses. Obamacare also provides subsidies to keep costs down.,but on repeal, they will likely be gone or replaced by something less expensive. Obviously. if you take all of those people who are really sick or who have a history of illnesses out of the general risk pool then premiums for the well people could be reduced significantly, but then where do those with preexisting conditions go? Well, that takes us directly to the “High-Risk Pool” and the state will have to cover most of those costs.

When Donald Trump was a candidate for the Presidency he made these promises:

trumpcare“I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now. … The government is gonna pay for it.” —On 60 Minutes, Sept 27th, 2015.

  • “We’re going to have great plans. They’re going to be much less expensive and they’re going to be much better. … That’s just human decency.” —Town hall, Feb 17th, 2016
  • “So it’ll be better healthcare, much better, for less money. Not a bad combination.” —On 60 Minutes, Nov 13th, 2016.
  • “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us. … We’re going to have insurance for everybody.” —Interview with Washington Post, Jan 14, 2017
  • “We will take care of our people, or I’m not signing it. … If we’re not going to take care of the people, I’m not signing anything.” —Fox News, March 15, 2017.

From those promises, most people inferred that Obamacare would be improved and everyone agrees that it should be.

It should have been saved and repaired, there was no need to reinvent the square wheel,

And from where I sit, that’s the truth


3 thoughts on “Pre-existing Conditions Explained, Pregnancy Coverage Not Assured

  1. Good one again, Bob.
    Maybe they can’t see that leaving things up to states is a good way to sweep them under the rug. When civil rights was left up to the states, the South decided it wasn’t a problem. Leaving healthcare up to states would put the poor into the tender mercies of the red states.

    Stupidity is the same as evil if you judge by the results.
    M. Atwood


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