Dealing with Pre-Existing Conditions

November 15, 2018

by John McClaughry

During the last national election campaign Democrats scored points by attacking Republicans for wanting to deny health insurance to people with pre-existing conditions. The Republicans couldn’t muster a good answer, even though they had one readily available.

The Patient Care Act, the leading Republican alternative, was designed to deal with just this problem. Persons who stayed continuously insured would be allowed to move between insurance coverage platforms without their health status factoring into the premiums they must pay for coverage.  The 1996 Health Insurance Portability and Accountability Act included provisions aimed at easing the transition between group coverage and state-regulated individual market plans.  But the provisions addressing those transitions left gaps through which many people can, and do, still fall.

The Republican bill would have filled in those gaps, required state-regulated insurance plans to offer coverage to the continuously insured, and to guarantee its renewal.  The continuous coverage requirement does not need to be burdensome.  It can be satisfied through the purchase of low-cost catastrophic coverage as well as more comprehensive insurance plans.

There would have been a one-time open enrollment period during which persons who had not been previously insured could opt into coverage without facing higher premiums based on their health conditions.

These are reasonable provisions. Coupled with Federally-funded state high risk pools, they would have decisively refuted the Democrats’ political attack.  Too bad the Republicans didn’t mount a powerful counterattack on their opponents’ falsehoods.

John McClaughry is vice president of the Ethan Allen Institute.

{ 1 comment… read it below or add one }

Steve Jackson December 1, 2018 at 3:49 am

There are no pre-existing conditions if you are required to have at least a catastrophic insurance policy at birth. Parents can select and afford the best policy for their children in a free market place with insurance companies competing across state lines.

This plan, by its very nature, is phased in over time gradually reducing costs for both citizens and governmental programs as the private sector is allowed to compete to keep costs down and customer satisfaction high. Insurance and medical treatment affordability for most will be alleviated in three generations or in just one generation if all people, not just the newborns, are required to have at least catastrophic insurance for themselves.

The catch is that government must not be allowed to set the rules or sell any insurance as big government, by definition, invites big corruption, price overruns and inefficiency.


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The Ethan Allen Institute is Vermont’s free-market public policy research and education organization. Founded in 1993, we are one of fifty-plus similar but independent state-level, public policy organizations around the country which exchange ideas and information through the State Policy Network.

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