Pre-existing conditions coming back thanks to Republicans?

“Today we saw a clear contrast: Democrats are working to fix and improve the Affordable Care Act, while Republicans still want to go back to the days when insurance companies could deny people coverage for pre-existing conditions, treat being a woman as a pre-existing condition, and watch health care costs drive families into bankruptcy.”

—Senate Majority Leader Harry Reid, Nov. 14, 2013

 

Overview

Reid has a point that Republicans want insurance companies to keep the ability to limit risk by refusing coverage to some customers.  But he exaggerates the contrast between the parties.

The Facts

With insurance companies terminating hundreds of thousands of policies during the 2013 transition to ACA-compliant insurance policies, Congress proposed legislation to ease the rules under which insurance companies might continue to allow customers to keep their old policies.

On Oct. 28, 2013, Rep. Fred Upton (R-Mich.) proposed such a bill in the House of Representatives.  Sen. Ron Johnson (R-Wisc.) presented a similar bill to the Senate on Oct. 30.  Sen. Mary Landrieu (D-La.) offered a Democrat version of the bill on Nov. 4.

Senate Majority Leader Harry Reid issued a press release about the ACA on Nov. 14, saying in part (bold emphasis added):

Today we saw a clear contrast: Democrats are working to fix and improve the Affordable Care Act, while Republicans still want to go back to the days when insurance companies could deny people coverage for pre-existing conditions, treat being a woman as a pre-existing condition, and watch health care costs drive families into bankruptcy. The fix proposed by President Obama today is an important step towards addressing a problem that has arisen and if we need to do more, we will.

 

The fix Obama proposed, allowing insurers to renew cancelled plans for one more year in the non-group market, would allow those plans to refuse coverage because of pre-existing conditions and use gender rating in setting premiums.

During Senate debate on Nov. 14 a number of Republicans called for repeal of the ACA.  Some of the same Republicans called for a new bipartisan reform bill to replace the ACA.

Analyzing the Rhetoric

What was Reid talking about?

We considered the possibility Reid referred to plans like those from Upton and Johnson.  Those plans allow insurance companies offering grandfathered plans to continue refusing coverage for pre-existing conditions while also preserving the option of gender rating:

In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don’t have to:

• End yearly limits on coverage

• Cover you if you have a pre-existing health condition

 

All the extensions of the availability of grandfathered plans have that in common, though certainly they differ in some other ways.  Given the continued existence of grandfathered plans, the days of denying coverage for pre-existing conditions never went away.  Grandfathered plans were always exempt.

The repeal or repeal-and-replace group

We decided Reid was most likely describing Republicans who advocated repeal of the ACA as they made comments on Nov. 14.  But does advocating the repeal of the ACA mean insurance companies would continue to refuse coverage for pre-existing conditions?

Very likely.

Republican models for health care reform typically leave insurance companies the freedom to limit their risk pools, as by refusing coverage of pre-existing conditions.  Such plans do not entirely ignore the plight of people unable to buy insurance because of pre-existing health conditions.  One current GOP plan relies on government funding for separate high-risk pools.

McClatchyDC reported the reaction of health care expert and single-payer advocate Jonathan Oberlander of the University of North Carolina Chapel Hill to that GOP plan:

[Oberlander] said that interstate insurance purchases aren’t feasible and high-risk pools have been tried before and aren’t a substitute for the insurance protections under the Affordable Care Act for people with pre-existing conditions.

 

Regardless of whether a GOP adequately provides for high-risk insurance pools, GOP plans preserve an insurance market able to limit risk by refusing to cover pre-existing conditions.  In that sense, at least, Reid spoke accurately.

We addressed in an earlier fact check the claim that being a woman counted as a pre-existing condition.  Reid’s version of this claim can count as a hyperbolic way of referring to gender rating.  Women tend to cost more to insure when they’re younger, so insurance companies charge them more.  When men and women age, men tend to cost more to insure and are charged accordingly.  The ACA flattens out those price differences so that young men pay more for insurance than their risk would otherwise justify.

Summary

“Republicans still want to go back to the days when insurance companies could deny people coverage for pre-existing conditions”

While it’s true that Republicans want to preserve insurance companies’ ability to control risk by denying coverage for pre-existing conditions, the Democrats’ ACA bill and its suggested fixes continue to keep that ability on a limited and shrinking basis.  We exercise moderately charitable interpretation to overlook that caveat.  Secondarily, Reid’s statement leaves his audience no clue that Republican plans offer some relief to those having trouble obtaining insurance.  Reid’s omission can lay a rhetorical booby trap for his audience, leading them to believe Republicans offer nothing of the kind.

“treat being a woman as a pre-existing condition”

Taken as hyperbole, Reid is right that Republicans likely favor allowing insurance companies to engage in gender rating.  But people might easily think Reid means it literally, so we give Reid the benefit of the doubt with moderately charitable interpretation.  Gender rating does not discriminate on the basis of gender alone.  It discriminates based on health care costs connected to gender.  Rhetoric like Reid’s confuses people with a fallacy of ambiguity.

Afterword

We skipped rating the end of Reid’s claim, where he said Republicans wanted to go back to a time when we would watch medical bills drive people to bankruptcy.

We skipped that claim because it would take a great deal of space to cover adequately.  Likewise we’ve tabled the issue of whether the fixes suggested by Democrats offer promising solutions to the ACA’s implementation problems.

 

References

Reid, Harry. “Reid Statement On Affordable Care Act.” Senate Democrats. United States Senate Democrats, 14 Nov. 2013. Web. 20 Nov. 2013.

“Upton to Introduce Keep Your Health Plan Act.” Congressman Fred Upton. U.S. House of Representatives, 28 Oct. 2013. Web. 20 Nov. 2013.

“Press Releases.” Ron Johnson, United States Senator for Wisconsin. United States Senate, n.d. Web. 20 Nov. 2013.

United States. United States Senate. If You Like Your Health Plan, You Can Keep It Act. Ron Johnson, 30 Oct. 2013. Web. 20 Nov. 2013.

“Landrieu Introduces Bill To Ensure Individuals Can Keep Health Plan If They Like It.” Senator Mary Landrieu. Senator Mary Landrieu, 4 Nov. 2013. Web. 20 Nov. 2013.

“U.S. Senate Nov. 14, 2013.” C-SPAN. C-SPAN, 14 Nov. 2013. Web. 22 Nov. 2013.

Benen, Steve. “Obama Proposes Health Care Fix.” MSNBC. NBC Universal, 14 Nov. 2013. Web. 22 Nov. 2013.

Trese, Heather. “Gender Rating in Health Insurance: Fair Practice or Discrimination?” LifeHealthPro. LifeHealthPro, 1 Oct. 2009. Web. 22 Nov. 2013.

Schoof, Renee. “A Frequent Obamacare Critic, Rep. Ellmers Says GOP Has Its Own Plan.” McClatchyDC. McClatchy Washington Bureau, 14 Nov. 2013. Web. 22 Nov. 2013.

White, Bryan W. “Was Being a Woman a Pre-existing Condition before Passage of the ACA?” Zebra Fact Check. Zebra Fact Check, 6 Oct. 2013. Web. 22 Nov. 2013.