President Obama held his much-anticipated summit on health insurance reform two weeks ago. His stated goal was to listen to Republican suggestions about health insurance in hopes of achieving a breakthrough on the legislation passed by both houses of Congress but stalled after Massachusetts voters denied the Democrats the filibuster-proof majority they needed to finalize the bill.
If the goal of the summit was to reach a consensus on health care insurance, it was a failure. While the Democrats took pains to suggest that they and their Republican colleagues were not that far apart on a host of issues, neither side was willing to concede anything to the other. The summit ended with no agreement on policy, nor even a commitment to find agreement.
As an insurance professional, I was amazed by the gaps in understanding of present-day health insurance and embarrassing gaffes some members of Congress made as they tried to discuss health insurance.
The most egregious misstatements were made by Representative George Miller, a Democrat from California. Miller wanted to dramatize the need for reform in the area of delaying or denying coverage for preexisting conditions, but it was obvious from his statements that, as a member of Congress for the last 35 years, he has no idea what life is actually like for someone seeking health insurance coverage.
He started out by trying to say that because he had two hip replacements, he would not be able to obtain health insurance if he had to change jobs. “I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone,” Miller said. “I’m dead in that insurance market if I have to switch policies or switch companies or look for another chance. Now, why should that be? Those hip replacements have been with me for 15 years and I have no trouble. But it’s a way of denying me care.”
Miller is wrong on several counts.
First, he would not be dead in the private health insurance market if he switched to another group health insurance plan, because group health insurance plans cannot deny or delay coverage for preexisting conditions by law.
Second, he would not be dead in the private health insurance market if he switched to an individual policy, provided he did so within 63 days of terminating his existing coverage. You would think Congressman Miller would know that, because he voted for the very law that guarantees portability in health insurance coverage, the Health Insurance Portability and Accountability Act (HIPPA). Passed by Congress in 1996, HIPPA states that anyone who obtains new health insurance coverage within 63 days of losing or ending an old health insurance policy will be deemed to have “continuous coverage.” As such, the period of coverage preceding the new enrollment will be subtracted from any waiting periods for preexisting conditions. By having continuous coverage for 35 years through the U.S. Congress, Congressman Miller will not have to worry about any waiting periods for his arthritis or kidney stone.
Third, Congressman Miller, who is 65, has the option of signing up for Medicare, the taxpayer-funded health insurance program for seniors, and he cannot be denied coverage for it because of preexisting conditions. I’m not suggesting that Representative Miller should drop his private health insurance altogether; he can use Medicare as supplemental care. But it is there if he needs it. More importantly, it underscores the fact that millions of Americans who have preexisting conditions cannot be denied coverage because they already qualify for government healthcare through Medicare, Medicaid, S-CHIP, Veterans Administration, and other programs such as California’s Healthy Families.
Not only were Representative Miller’s examples false, but his conclusion was wildly off the mark. Insurance companies are not evil entities, groping around for ways to deny coverage. As I have explained in this space before, they are functioning exactly as any insurer does, using actuarial science to maintain the balance between premiums and losses. Since they already are forced by law to accept people with costly preexisting conditions in their group policies, they need to draw the line at what they can cover without going out of business.
That is why I wrote my Congressman to tell him my idea about super funds for the truly uninsurable. If we want to show compassion for people in the late stages of a disease and care for them, fine. Let the taxpayers pay for those extremely rare cases. But there is no need to hijack the whole system for the sake of a few.
Representative Miller, President Obama, others who talk about people losing health coverage when they are sick are guilty of misleading the public about practices of the private health insurance industry. They tell sob stories about lost coverage, not because it is rampant, but because they are trying to manipulate the public. They know Americans are compassionate, so proponents of health insurance reform are using these stories build support for the legislation based on a false premise. That is why I say we should set up a separate fund for the truly uninsurable. Then we will know exactly how many there are, exactly how much it costs to care for them, and taxpayer money is going to cover them and only them.
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