Pre-Existing Conditons Must Not Be Forgotten

In recent posts I’ve seen it as a favorable sign that David Plouffe is now advising Barack Obama. I’ve also supported reintroducing health care reform and winning back the support of the American people before feeding into hypocritical Republican complaints regarding abuse of power by ramming through the flawed Senate plan. I’ve supported making some changes in the current legislation, and might even accept a scaled back program if this turned out to be the best way to incrementally improve health care.

One thing I would not like to see is abandoned is the elimination of restrictions on pre-existing conditions. As Jon Avarosis points out, Plouffe writes that “Parents won’t have to worry their children will be denied coverage just because they have a preexisting condition.” In addition to being limited to children in Plouffe’s op-ed, some recent news coverage also suggests this might be the current plan.

Plouffe also does write, “Workers won’t have to worry that their coverage will be dropped because they get sick.” However this leaves open the question of people who do not currently have coverage.

This might be motivated by the opposition to the individual mandate which is coming from many on both the left and the right. The danger is that if insurance companies have to cover everyone  many healthy people will not purchase insurance until they become sick, knowing they cannot be denied. There are other solutions to this free rider solution other than the individual mandate. It could be handled comparable to how Medicare handles the voluntary prescription drug program where there are open enrollment periods but otherwise those who fail to purchase coverage cannot buy it at any time they choose.

We could have such an open enrollment period in which everyone could purchase insurance despite pre-existing conditions after passage of the bill and upon reaching an age where they are no longer covered by their parents, but if they fail to take advantage of this they remain subject to insurance company rules on coverage for pre-existing conditions. Other incentives could also be granted to those who decide to purchase insurance, such as vouchers or subsidies for coverage which are limited to those who sign up after passage of the bill.

People over forty have the hardest time obtaining insurance coverage on the individual market due to pre-existing conditions. Another consideration might be to allow such people to buy into Medicare. The one drawback to this is that it might lead to sicker people buying into Medicare while healthier ones continue under private insurance, making it more expensive to care for Medicare patients. Perhaps it would be simpler and fairer to lower the age of Medicare for everyone, with premiums paid into the Medicare system instead of paying for private coverage.

There is also one very simple measure which at very least should be considered. At present if someone is covered by a group plan and changes to another group plan exclusions on pre-existing conditions do not apply. However people purchasing insurance on the individual market have to start all over with exclusions for pre-existing conditions should they desire to change insurance companies. We should make the rules for individual policies the same as for group policies so that there cannot be exclusions for pre-existing conditions for going from one policy to another.

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