One thing I’ve noticed while watching the new wave of Obamacare change discussions is that some Republican members of Congress say they want to ban preexisting condition exclusions.
One problem with Obamacare repeal, repair and replacement discussions is that the participants rarely give a clear statement about what they think the word “Obamacare” means.
They sometimes seem to be well-informed people who are using the term to refer to every last character in the Affordable Care Act statutory package: the Patient Protection and Affordable Care Act of 2010 and the health-related provisions of the Health Care and Education Reconciliation Act of 2010.
In other cases, the discussion participants seem to be referring only to the parts of PPACA and HCERA that related to Medicaid or commercial health insurance.
In still other cases, the participants seem to use the word Obamacare to refer only to the Affordable Care Act public exchange program, the mandate that requires many individuals to own coverage or else pay a penalty, and the mandate that requires many employers to offer health coverage or else pay a penalty.
My suspicion is that one reason members of Congress bluster so much about the ACA is that they know too little about it to talk about how it really works, or fails to work. They can’t pound on the facts, so they pound on the table.
The talk about a ban on pre-existing exclusions seems to be another example of fuzzy language leading to fuzzy thinking.
Some would-be Obamacare replacers say they want to ban pre-existing condition exclusions, even after the ACA goes away.
But a pre-existing exclusion is simply a health coverage provision that lets a health insurer put off covering a specific health problem for some period of time, or for all time.
Allowing or banning pre-existing exclusions may indirectly affect the cost and availability of coverage, but it has nothing directly to do with whether people with health problems can get health coverage, or whether those people will pay the same rates that everyone else pays.
That raises the question: Are lawmakers talking about banning pre-existing condition exclusions, at least for people who are diligent about paying to keep their health coverage in place, because they personally think banning pre-existing condition exclusions means the same thing as banning medical underwriting?
Or, do those lawmakers actually know the difference between a ban on pre-existing condition exclusions and a ban on medical underwriting? Are those lawmakers cynically counting on most voters being too ignorant to know the difference?
If the lawmakers are trying to fool the voters, by pretending to want to keep the ban on medical underwriting, even though they know they want to get rid of it: I think that’s a mistake.
People may have reasonable disagreements about whether we can, or should, try to keep any, all or some of the current major medical underwriting restrictions in place. But, if voters who thought Congress was going to keep most of the current ban on medical underwriting in place discover that lawmakers conned them, by just giving them a ban on pre-existing condition exclusions, that’s going to make it hard for members of Congress to get voters to trust them on other tough health policy matters in the future.
Eventually, we’re probably going to have to make unpleasant decisions about Medicare and Medicaid benefits. To get through that period, policymakers are going to have to persuade everyone that taking bitter medicine is necessary to keep us going. Efforts to pretend that ACA-change wormwood tastes like cotton candy won’t do much to create that much-needed climate of trust.
If some of the most visible participants in the discussions actually think a ban on pre-existing condition exclusions is the same as a ban on medical underwriting, maybe that’s even more frightening than the idea that the participants are cynical.
Either way, it seems as if the policymakers in Washington have a dire need to meet people like you, who know how to talk to your clients about unpleasant, complicated subjects without getting into compliance problems.
The National Association of Health Underwriters is bringing people like you to Washington this week so that you can hear from the movers and shakers inside the Beltway. But, of course, the very obvious truth is that, whether those movers and shakers know it or not, they desperately need to hear from you much more than you need to hear them.
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