What a stupid debate.
No, no, I’m not talking about last Tuesday night’s tangle between President Donald Trump and former Vice President Joe Biden (although it would have been nice to hear a complete thought every so often).
Rather, I’m talking about one the candidates only briefly mentioned that evening, but which is prominent in this election year: the debate over how to help those with pre-existing conditions. It’s a stupid debate because neither side is approaching it with clarity.
Democrats say Republicans will strip these Americans of legal protections against denial of coverage or service by health insurers. Republicans say there’s a national consensus for those protections which they won’t violate.
At issue is the Affordable Care Act, a.k.a. Obamacare. Democrats were prepared to abandon the law until this year’s presidential primaries, when they realized voters didn’t like their (even more) socialized plans. Now Biden promises to fix the law by expanding it. Republicans gave him that opening by being unable to articulate the many positive, if smaller, steps the Trump administration has taken on healthcare, much less a bigger vision.
That helps explain why the back and forth is so unenlightening. Let’s look at pre-existing conditions in more detail.
You’ll recall that the inability of those with pre-existing conditions was a key justification given for the ACA. Proponents wanted you to believe there were huge numbers of Americans who fell into this category, and that’s why Congress needed to wrest control of the individual insurance market from states and make new rules for it.
But the ACA was not the solution.
While the number of people with a pre-existing condition is large – Biden said it’s 100 million during the debate; Speaker Nancy Pelosi has said 135 million – few of them shop on the individual market and thus depend on the ACA’s protections. That’s because the vast majority of Americans with private insurance get their coverage through their employer, and group plans have been required to include those with pre-existing conditions since 1996.
After that, a quarter of uninsured Americans in the late 1990s reported having “poor health,” but only 3.5 percent said their health kept them from getting coverage, according to a study by the Congressional Budget Office. That worked out to roughly 2 million people.
Even if the problem got worse over time, the ACA was of limited help. Besides regulations, the law created a program for those who had been uninsured for at least six months and had been denied coverage, including for a pre-existing condition. The federal government projected enrollment of 375,000 by 2010, and 400,000 by 2011. But enrollment was less than 49,000 by the end of 2011 and never hit even 115,000.
Now, the point isn’t that this is a “small” problem. These are only small numbers if you aren’t included in them. Those affected have big, real-life problems.
The point is the ACA was a poor way to solve those problems. Rather than targeting solutions to those who were uninsured because of their health status, the ACA spread their very high costs on to the relatively few people buying insurance on their own. Individual-market premiums skyrocketed, provider networks narrowed considerably, and enrollment slipped. If your plan isn’t heavily subsidized by the government – based on income, not health condition – the main effect of the ACA was to make insurance cost more.
Both blue and red states, including Georgia, are taking an approach that could render the pre-existing debate moot. Through state reinsurance plans – such as the one Gov. Brian Kemp included in his request to waive some of the ACA’s requirements – states can pay directly for the disproportionate expenses of sicker patients while pushing premiums lower for others.
Again: They’re doing that by moving away from the ACA, not closer to it. They’re doing it by focusing on a specific problem, not a government takeover of healthcare. Those methods will work in other ways, too.
If only someone would tell Americans about it.
• Kyle Wingfield is president and CEO of the Georgia Public Policy Foundation: www.georgiapolicy.org.