Health reporters have difficulty writing about preexisting conditions accurately.
This article, for example, commits a number of errors when it states: “About 54 million, or 27%, of U.S. adults under age 65 had a pre‐existing condition in 2018 that would have rendered them uninsurable on the individual insurance market before Obamacare, according to an analysis by the Kaiser Family Foundation.”
- First, it is not accurate to say those conditions were uninsurable on the individual market. The individual market could have insured maybe 99.99 percent of them with secure, long‐term coverage. All that was necessary was that those individuals purchase coverage before those conditions manifested themselves. The reason the individual market didn’t is that the federal government, via the tax exclusion for employer‐paid premiums, effectively penalizes those individuals if they purchased secure, long‐term, individual‐market coverage. So right there, the article is blaming the victim.
- Second, the vast majority of those conditions were insured. Unfortunately, since they were insured through employer‐sponsored insurance, it was short‐term coverage that would last only as long as their relationship with the employer. When that relationship ends, so does the insurance. Crucially, what would have continued to be insured conditions on the individual market instead became uninsured and uninsurable preexisting conditions. This is not the fault of the individual market! It is a consequence of government penalizing people if they used the individual market. This error recurs when the article states, “Among those hurt most under the prior system were older adults who were laid off before age 65, who couldn’t find affordable coverage — or any coverage at all — to hold them over until they became eligible for Medicare.” The “system” that leaves these folks without coverage is not the individual market; it is the government. And it is not “prior.” With every passing day, federal tax policy is still turning otherwise‐insurable conditions into uninsured and uninsurable preexisting conditions.
- Third, ObamaCare does not make those conditions insurable. It uses coercion to subsidize them. There is a big difference. Insurance is the pooling of like risk. If a health loss has already occurred, it is no longer a risk; it is a loss. ObamaCare does not and cannot insure a health loss that has already materialized, any more than one can insure a building that has already burned or a car that has already crashed. Insurance aligns incentives so that people voluntarily pay the medical bills of complete strangers. ObamaCare attempts to pay people’s medical bills by forcing others to act against their own perceived economic self‐interest (to buy coverage they don’t want, to pay inflated premiums, to pay higher taxes, etc.). That is not insurance. The incentives for people to defect from such coercive arrangements are far greater, which means far more patients fall through the cracks.
Additional problems appear in this sentence: “Rhetoric aside, Trump’s actions as president have actively undermined pre‐existing condition protections, some experts say.”
- First, it begins with “rhetoric aside” but ends by employing ideological rhetoric. The above links detail just some of the problems ObamaCare’s preexisting conditions provisions are creating for all enrollees, but particularly for very sick patients. It is therefore at best incomplete and at worst propaganda to refer to those provisions as “protections.” ObamaCare supporters call those provisions “protections” to hide that there are inherent tradeoffs, including higher premiums and lower‐quality coverage. To call those provisions “protections” is to engage in card‐stacking ideological rhetoric–i.e., to disseminate propaganda. A better, ideologically neutral term is “provisions.”
- Second, speaking of neutrality, the article does not acknowledge that other researchers (ahem) argue Trump has expanded protections against preexisting conditions and done more to solve that (largely government‐created) problem than Biden has. Allowing consumers and insurers to make full use of the exemption for short‐term, limited duration plans can help save people from “the prior system,” which strips people of their coverage and leaves them with uninsured and uninsurable preexisting conditions. It can even save people in employer‐sponsored plans from ending up with an uninsured and uninsurable preexisting condition. The article makes no mention of this feature of short‐term plans.
Getting this stuff right is hard. The economics of preexisting conditions is complex. An even bigger challenge is that any reporter who wants to get it right will run into an buzzsaw of health policy wonks, reporters, and editors who will disagree with whatever they write.