PRE-Existing Conditions And Obama-Care Research Proposal
On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act into effect. It became the new governing law of the land concerning health care and insurance companies. This was one of the most significant changes to the medical and insurance industries ever, so as a result, there is much debate and scrutiny about the specifics of the bill. The Affordable Care Act (ACA) had the goal of increasing quality and affordability of health care insurance, and to especially lower the uninsured rate. It formed a website, insurance exchanges, and subsidies to help people afford care. One of the ACA’s most popular measures was that of expanding coverage to persons with pre-existing health conditions. Under the ACA, insurance companies must insure those with pre-existing health conditions, at no greater cost than anyone else. However, this policy raises the question as to whether or not a system like this is feasible in the future.
Under the ACA, insurance companies cannot deny coverage or charge more for people with preexisting conditions. In fact, they cannot deny any person for any reason other than fraud. They also are not allowed to put dollar limits on areas deemed “Essential Health Benefits.” Many of these areas include screenings, preventions, and treatment for life threatening diseases like cancer (“ObamaCare Facts”). The next question to address is just how common pre-existing conditions are in America. According to the CDC, 75 percent of all healthcare spending is for the treatment of chronic diseases, most of which are preventable. Furthermore, chronic diseases cause 7 out of 10 deaths per year in the United States, and almost half of all Americans have at least one chronic illness (“ObamaCare Facts”).
Clearly, the issue of how to handle pre-existing conditions is a major one; in fact, this is arguably the most important aspect of the ACA, as it has the potential to impact half the country. The pre-existing conditions policies are the reason for the other, more controversial sections of the bill, such as the mandate for every person to buy insurance or pay a fee. The logic dictates that the only way to pay for coverage of sick people is to insert more healthy people into the system. That is why the ACA allows coverage for children to be on their parent’s policy until age 26 (ObamaCare Facts). It is also why a fine is imposed if someone refuses to purchase coverage. More people, who do not need much from the health care system, are needed to offset the costs. However, this way of handling insurance is not the norm for most industries.
Typically, an insurance company operates under “risk assessment.” Those who have more risk in a certain area are charged a higher price. This is true in all other forms of insurance, such as vehicle or home. Multiple traffic accidents will cause higher premiums in vehicle insurance. However, under the ACA, this is not the case with health care costs. Those people who have pre-existing conditions can now get coverage at no more cost than anyone else. The reason for this is that health insurance is different than all other types of insurance. Health insurance has the most direct impact upon life and death than any other type of insurance. Those with pre-existing conditions depend on prescriptions drugs, screenings, and other preventative procedures, and they should be guaranteed this right, regardless of income. Not having this coverage could ultimately lead to death, but most likely result in bankruptcy and a lower quality of life. Therefore health coverage is more important and different, based on the complexity of the system, than any other type of insurance.
This leads to the final issue of pre-existing conditions and the ACA, which is the long term feasibility of the plan. Because those with pre-existing conditions cost more to insure, someone else will have to take on the cost. While the ACA has a way to deal with this problem, will their solution actually work? Can the ACA survive without having insurance companies factor in a person’s “risk assessment?” There are a number of studies that say this is not feasible, and a few changes will have to be made to the system in order to actually take care of those with pre-existing conditions, and not completely inflate costs for all.
The problem with the equal treatment for all regardless of condition is due to costs. Costs of premiums will go up for everyone, so those without pre-existing conditions will be hit hard. Therefore there is some middle ground regarding the “risk assessment” of health insurance. One study found that grouping all the high-risk candidates in a separate pool, and have state’s subsidize the extra cost would be a better option. This would keep the costs for both those with pre-existing conditions down, as well as the regular person. This would also force every person to have a risk evaluation to determine which health insurance pool they should be placed in (Carpretta).
While there may in fact, be no perfect system, the issue of how to deal with pre-existing conditions is a controversial one, and something that is not completely solved by the ACA. It is better than the previous system, as there is more access for these types of people, but keeping costs down in the long run will be extremely hard. Future research and revision will be necessary in order to best handle the changing health care landscape in years to come.
James, Carpretta. "How to Cover Pre-existing Conditions." National Affairs, 4 Nov. 2010. Web. 22 Jan. 2015. <http://www.nationalaffairs.com/publications/detail/how-to-cover-pre-existing-conditions>.
"ObamaCare Facts." Obamacare Facts: Affordable Care Act, Health Insurance Marketplace. Web. 22 Jan. 2015. <http://obamacarefacts.com/>.