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It Should Be Criminal to Let Health Insurers Deny Coverage Based on Pre-Existing Conditions

Instead, the Trump administration, Florida, and 19 other states are fighting in court to make it permissible business again

healthcare rally

Protestors demonstrate during a healthcare rally at Thomas Paine Plaza on February 25, 2017 in Philadelphia, Pennsylvania. (Photo: Mark Makela/Getty Images)

Imagine this scenario. Flagler County Sheriff’s deputies are arresting a man for domestic violence. They read him his Miranda rights. Then they ask him a question: Have you been arrested or found guilty of any crime before? The man says yes, he has. A couple of times. Ah, in that case, the cops tell him, you’re free to go. We don’t arrest people with a pre-existing record, only those with a clean record. Makes our life easier and we don’t have to waste time and money on you losers.

That, of course, would be absurd, insane, and unacceptable. But it’s exactly what health insurance companies used to do with people who have pre-existing conditions, and it’s what they want to do again: Insure those who are well. Let those who are not fend for themselves. It’s as retrograde a reversal of what health insurance is intended to be as if law enforcement were to arrest only first-time offenders and let repeat offenders go on their way. 

We’d never accept that from police chiefs and sheriffs. Why would we accept it from politicians and state government agencies? But we are.

Last month the Trump administration filed a court brief, joining 20 other states, Florida among them, in a lawsuit that seeks to throw out the requirement of insurance companies to cover pre-existing conditions. The states are actually arguing that Obamacare is entirely unconstitutional. The Trump administration isn’t going that far. It doesn’t need to. It’s done plenty to plunder the Affordable Care Act as it is, eviscerating so many of its provisions—cutting off subsidies, aborting birth control coverage, curtailing enrollment helpers, and actually shutting down the Obamacare website periodically (shutting down a website?), among other gouging—that the law is already an invalid hobbling in most states. But covering pre-existing conditions had become a moral red line. Then again, moral lines are mere squares in Trump’s hopscotch, there to be hopped on the way to sadism’s plum pudding. 

There are many reasons to dispute the validity of Obamacare. The requirement to cover pre-existing conditions is not among them. It is the most popular provision of the 2010 law, because it’s its most effective one. Without it, Americans would go back to the days of bankruptcy by illness, and worse. No coverage doesn’t mean no care, but it means less care, much less preventive care, and more early, unnecessary deaths. As Jimmy Kimmel famously said after his son’s emergency heart surgery last year, “if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.”  Covering pre-existing conditions is also a principal  reason health insurance exists, at least anywhere civilized health insurance exists: Life is a pre-existing condition. The rest is endurance. 

The point of health insurance is that it’s there when you get sick. That’s why you pay premiums for your whole life, most of it healthy you hope. And if you happen to have diabetes or cancer or had a C-section, that shouldn’t count against you. Instead, insurers want to return to the days when pre-existing conditions, as arbitrarily defined as drug offenses, are the equivalent of a prior criminal record, there only to aggravate your sentence: Not only will you get no coverage, but you’ll get blacklisted across the industry. Until 2010 when Obamacare kicked in, the United States was the exception in the developed world where insurance companies could cherry-pick their clients. It was a simple way for actuaries and annual report fantasists to minimize services and maximize profits. 

But Obamacare has done nothing to dent profits. It’s been sending them to new highs. Trump’s own White House this year reported that “the stock prices of health insurance companies rose by 272 percent from January 2014 to 2018, resulting in improved profitability and outperforming the S&P 500 by 106 percent.” 

Still, insurers want to eliminate coverage for those who need it most, going back to times when they could deny one in seven people for that reason. It’s part of the ideology of greed that’s redefined the purpose of essential services. The insurance industry is not here to help you while making a decent profit along the way. You are here to help the industry make obscene profits, pouring in your premiums while you’re healthy and kindly getting out of the way when you get sick. And government should help business get its way. That’s what Florida Attorney General Pam Bondi is pushing for by joining that lawsuit. That’s what the Trump administration is hoping for by lending it its voice. 

The GOP line on pre-existing conditions was summed up by former New York Lieutenant Governor Betsy McCaughey when she argued that “Obamacare discriminates against healthy people who have to buy their coverage in the individual market,” forcing them to “pay the same price as the chronically ill, whose medical costs are ten times as high, on average.” Odd. I never hear that kind of wishful means-testing applied to Medicare provided to anyone over 65 at the same price, whether the recipient is an obese hedonist with sirloin bile for arteries and $5 million of care ahead as opposed to that of a svelte ascetic whose cost of end-of-life care will approximate that of dust. Totalitarian regimes used to send the bill for the cost of an executioner’s bullet to the family of the executed. Would McCaughey be comfortable sending Medicare’s bills to the family of the expensively departed?

The point is that unless we’re ready to tax butter, sugar, carbs, girths, and couch potatoes, and raise armies of government pantry raiders and dossiers on every American’s eating and exercise habits (something corporations and governments are doing to excess as it is with their intrusive and baseless wellness programs), it’s not up to us to judge whose care will cost more and why anymore than it’s up to a faceless insurance company to decide who is worthy of coverage and who isn’t. If it’s big government you’re worried about, you’re barking up the wrong call center. Your insurer’s presumptions are the death of you—assuming you’re not lucky enough to be on Medicare, in which case you can be a hypocrite to your clogged arteries’ content and bitch about those younger moochers and cancer losers at the other end of the healthcare scale. 

You think I’m exaggerating? This is the assurance I got in this month’s “newsletter” from my insurer, Florida Blue: “Before you get certain types of care, we ask your doctor to consult with our medical team to discuss and agree on the course of treatment.” A medical team that has more in common with shareholder value than tongue depressors will decide my fate. And we were once worried about mythical death panels. No mystery why that type of company would dance on the graves of clients whose pre-existing conditions it wishes it could shed. 

Eliminating coverage for those with pre-existing conditions is no different than applying the principles of Shirley Jackson’s lottery to human beings. You know the famous story you read in high school: when your number is up, it’s your turn to die. Granting insurers the power to decide whom to cover lets them play god with your health’s lottery. It’s cruel enough you might have been dealt a bad hand. It should be criminal to let insurers deny you coverage and brand you a loser on their balance sheet. Instead, Trump, Florida, and 19 other states want those crimes to be permissible business all over again. 

This country has a pretty sickening pre-existing condition and it doesn’t even know it.

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Pierre Tristam

Pierre Tristam

Pierre Tristam is a journalist, writer, editor and lecturer. He is currently the editor and publisher of FlaglerLive.com, a non-profit news site in Florida. A native of Beirut, Lebanon, who became an American citizen in 1986, Pierre is one of the United States' only Arab Americans with a regular current affairs column in a mainstream, metropolitan newspaper. Reach him at: ptristam@gmail.com or follow him through twitter: @pierretristam

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