Health Care Reform, Part 3: Preexisting Conditions

During our trip to New Hampshire, My Sweet Baboo and I spent some time visiting several covered bridges (this is the Coombs Bridge) in the area around Keene. The bridges are all restored, all on the National Historic Register, and all beautiful, but each is slightly different – long vs. short; lattice vs. closed in, and so on. They also have different restrictions on the height and weight of the vehicles that can pass over them.

We returned home yesterday evening and we were hanging with the kids last night, watching the news, and saw a commercial for a regional theme park which has several thrill rides. All of them have different restrictions for height, physical condition, and overall size of the people who are allowed on the ride. So you’re wondering, what does this have to do with health care reform? Well, the rules of the bridges and the rules of the rides are designed to deal with preexisting conditions - the condition of the user.

And, the concept of preexisting conditions is one of the more contentious issues in the health care reform conversation. There is one school of thought, supported by President Obama and many others, that there should be no exclusions for preexisting conditions – everyone should have coverage from day one for any illness or condition they may have, regardless of what it costs them or us to pay for benefit. There’s another school of thought which is that having waiting periods for pre-existing conditions is acceptable.

There is a mountain of horror stories from people who have been denied health insurance benefits for one of these conditions. Folks are always are quick to put the horror stories on the table, especially when cameras are rolling, or a reporter’s hovering nearby, but what’s not talked about quite so much is that there are protections for most of us under the HIPAA regulations, which have been in effect since 1996. For those of us who receive insurance through our employers, waiting periods are limited under these rules, as is the look-back period, which is the time period an insurer can go back into your health records to see if you’ve got any condition that may be considered preexisting.

In the big picture, consequences for preexisting conditions are everywhere in the insurance industry, not just in health insurance. Some of the obvious ones? Risk pools for bad drivers, who have to pay more for their auto insurance. Another example is with life insurance; if you don’t get a physical and disclose your medical history, your benefits may be limited, as with this AARP insurance. Logically, homeowner’s insurance would be more difficult to obtain or more expensive in areas prone to weather issues (hurricanes, tornadoes, or avalanches) or other risk factors - check out these questions. I did try to see if I could get any sense of the added cost if I had five or more smokers living in the house, a wolf hybrid dog, an all-wood home, no alarm system, 10 miles to a fire department, and 3 insurance claims in the past 5 years, vs. the reality (one smoker, darn him; no dogs; an alarm system; a fire hydrant across the street and a fire house five houses down; and no claims ever), but they don’t really offer a comparison online.

The point is, it makes sense, doesn't it, if you take the emotion out of it? Certain of our cars, houses, lives, and illnesses are more risky than others, and either they're going to cost more to cover, or there'll be a reduced benefit until the risk has passed.

Health insurance should not be a thrill ride. All health insurance carriers – mine included – need to follow the rules that govern waiting periods, just as they should follow all of the other rules that govern the industry; that’s a no-brainer. If they don’t, there are consequences, and there are layers of regulatory oversight designed to respond to cases where the carriers are not following the rules, and these should be enforced.

Consumers also should be prepared to follow the rules. Know what your policy says about preexisting conditions (and everything else); understand the consequences of not taking insurance when it's offered to you when you get a job, and also understand the consequences of not taking continued coverage if you're unfortunate and lose your job. If you follow the rules, and it doesn't seem like you're getting what you paid for, take steps to file an appeal, a grievance, an inquiry - whatever it's called under your contract.

Lastly, politicians should be prepared to discuss issues thoughtfully, with an understanding of legislation that's already on the books; they should pay a little less attention to reporters and cameras, and resort much less frequently to scary rhetoric which doesn't move the debate forward. That’s probably me asking for too much, as usual. But -- if the bar is being raised on consumers, and the insurance industry, and the financial industry, and the auto industry, I think we should raise the bar on the politics industry as well.