One of the biggest complaints about health insurance is that many companies deny coverage for pre-existing conditions. If you think about it, this is like asking someone to insure that your car can get you from point A to point B when it doesn’t have an engine. Doesn’t make much sense, does it? Certainly, you can see it’s a losing proposition for the insurer, who knows full-well they’ve given you the right to demand they drop in an engine for you.
But coverage for pre-existing conditions is one of the rallying points being used by the administration to sell health care reform, and it’s a rallying point to which the remaining Kool-Aid drinkers cling like conservatives cling to their guns and religion. President Obama is now saying it like it’s a magic mantra, and the Congress critters are repeating it like proper little parrots. Just the other day, in New Hampshire, Obama opined,
“This is not about putting the government in charge of your health insurance. I don’t believe anyone should be in charge of your health insurance decisions except you and your doctor.
“I don’t think government bureaucrats should be meddling but I don’t think insurance company bureaucrats should be meddling.”
And right on the administration’s own website, they state their plans for health care reform will:
Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
Sweet! No idea how we’ll pay for it but the problem’s solved, right?
Not so fast, Weedhopper. They are all lying.
HR 3200 contains the following:
Section 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS.
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
In order to understand what this really means, it’s necessary to go look up the dependencies. This is a very important point because those dependencies are being included, not specifically excluded.
PHSA section 2701(b)(1)(A):
IN GENERAL.-The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
PHSA Section 2701(d)(9): The term “health status-related factor” means any of the factors described in section 2702(a)(1).
Section 2702 (a)(1) of the PHSA says:
(a) INELIGIBILITY TO ENROLL.-
(1) IN GENERAL.-Subject to paragraph (2), …a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions arising out of acts of domestic violence).
(2) NO APPLICATION TO BENEFITS OR EXCLUSIONS.-To the extent consistent with section 701,…paragraph (1) shall not be construed–
(A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or
(B) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or overage for similarly situated individuals enrolled in the plan or coverage.
SEC. 701. INCREASED <<NOTE: 29 USC 1181.>> PORTABILITY THROUGH LIMITATION ON PREEXISTING CONDITION EXCLUSIONS.
(a) Limitation on Preexisting Condition Exclusion Period; Crediting for Periods of Previous Coverage.–Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if– (1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date; (2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and (3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the participant or beneficiary as of the enrollment date.
Not a whole lot of change when all is said and done, is there? This is what will give the federal government, through its numerous “advisory” committees, the right to decide when and what kinds of care will be provided. In exactly the same way that insurance companies today decide the risks they will take when insuring someone’s health.
Which makes the federal government no better than the “evil” insurance companies they are subtly and not-so-subtly villifying to get you to buy their snake oil.