The latest news about pre-existing conditions and health care reform reminds me of a man I’ll call Ed.
I met Ed in the mid-1990s while reporting on the state’s health care system. A self-employed engineer in metro Atlanta, he was frustrated because he couldn’t buy health insurance.
Ed’s insurance problem? He had cystic fibrosis.
The rules of the insurance game angered Ed. He wanted change. “We’re all the mercy of the insurance companies,’’ he said then.
Fifteen years later, I have lost track of what happened to Ed, and out of respect for his privacy won’t give his last name.
Since then, though, pre-existing medical conditions have remained a problem for millions of consumers. Leaders of both political parties – though they differ on the fix – have agreed that insurance discrimination because of these conditions is wrong. No one likes the idea that people can’t get coverage because they were unlucky in the genetic lottery, with asthma, cancer or another health condition.
Late last week, the White House announced the state enrollment numbers for new ‘’high-risk’’ pools for people with those conditions. The pools were recently launched as part of health care reform – a stopgap until the law is fully implemented in 2014, when all the current restrictions on pre-existing conditions go away.
(That assumes, of course, that health care reform is still standing four years from now, surviving attempts to repeal it or cut off its funding.)
The new high-risk pool numbers were surprisingly low, both nationally and in Georgia. Here is Kevin Sack’s article in the New York Times on the enrollments, and Carrie Teegardin’s story in the AJC on the Georgia numbers.
One reason for the lag in enrollment is the cost of premiums. In Georgia, if you’re 55 or older, the monthly premium for the high-risk pool is $688, and there’s a $2,500 deductible. That’s pretty steep. And Georgians have to prove that an insurer has turned them down in order to qualify, along with being uninsured for six months.
A second factor for the low figures, experts say, is lack of marketing: Many consumers are not even aware that this program exists.
Meanwhile, the issue of pre-existing conditions looms as a tricky one for lawmakers trying to repeal or defund the reform law.
Reform opponents pushed the idea of high-risk pools as a solution. Yet the new enrollment numbers, as the Times article points out, show that this method may not work very well. The pools are expensive to run and pricey for consumers.
At the same time, reform opponents want to abolish the requirement for uninsured people to buy health insurance. But the insurance industry will never agree to abolishing pre-existing conditions if the requirement to buy coverage is dropped. Insurers need the healthy as well as the sick to balance their risk.
So pre-existing conditions will continue to be a sticky issue as lawmakers seek to block implementation of the Affordable Care Act. How they resolve the problem for people such as Ed will determine the ultimate success or failure of the political surgery being performed.