By Rich Lowry
Tuesday, May 09, 2017
If you’ve only followed coverage of the Republican
health-care bill loosely in the media, you might believe that House
Republicans, after much effort, passed legislation to deny people with
pre-existing conditions health insurance.
The issue of pre-existing conditions has dominated the
debate over the GOP health-care bill out of all proportion to the relatively
modest provision in the legislation, which is being distorted — often
willfully, sometimes ignorantly — into a threat to all that is good and true in
America.
The perversity of it all is that the legislation is
properly understood as doing more to preserve the Obamacare regulation on
pre-existing conditions than to undermine it. The legislation maintains a
federal baseline of protection in such cases, and says only that states can
apply for a waiver from it, provided that they abide by certain conditions
meant to ensure that no one is left out in the cold.
Since these provisions only involve the individual
insurance market, a small slice of the overall insurance picture (about 18
million are on the individual market), and merely make possible state waivers,
they are inherently limited.
You’re not affected if you get insurance through your
employer (155 million people), or through Medicaid or Medicare. You’re not
affected if you live in a state that doesn’t request the waiver, a category
that will certainly include every blue state and most red states, too. Even if
you buy insurance on the individual market and live in a state that gets a
waiver, you’re not affected if you’ve maintained insurance coverage
continuously and not had a gap in coverage longer than 63 days.
By this point, we’re talking about a fraction of a
fraction of a fraction of the population. If you do have a pre-existing
condition in a waiver state and haven’t had continuous coverage, you can be
charged more by your insurer only the first year. The state will have access to
$8 billion in federal funds explicitly to ease the cost of your insurance, and
the state must further have a high-risk pool or similar program to mitigate
insurance costs for the sick.
Clearly, if Republicans set out to recklessly endanger
the well-being of people with pre-existing conditions, they didn’t do a very
good job of it. The purpose of these provisions isn’t to punish people who are
sick, but to create an incentive for people to buy insurance while they are
healthy. (The Obamacare exchanges are failing because the law’s tangle of
regulations drove up costs and made insurance economically unappealing to the
young and healthy.)
It takes all of five minutes to understand the basic
architecture of the House bill on pre-existing conditions, yet it has been
subject to wildly ill-informed and deceptive attacks. Nancy Pelosi called the
provisions on pre-existing conditions “deadly.” Representative Frank Pallone of
New Jersey said the bill would hurt 129 million people with pre-existing
conditions, starting from an exaggerated figure and then assuming every single
one of them would be harmed by the House bill.
Such is the hysteria around this issue that using the
phrase “pre-existing condition” has become a license for making any charge
whatsoever. Feminists have spread word that the bill treats rape as a
pre-existing condition, a stupid lie that has been treated seriously in cable
TV debate. As the Washington Post
Fact Checker noted, not only does the bill not classify rape or sexual assault
as a pre-existing condition, almost all states have their own protections for
victims of domestic violence and sexual abuse.
There are certainly legitimate criticisms to be made of
the House bill, and ample room for the Senate to improve it, especially by
boosting its coverage numbers. But it is not an act of heedless cruelty against
the sick. As for its critics, their reflex to demagogic dishonesty isn’t a
pre-existing condition, just an ingrained habit.
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