The Preexisting Condition Issue Is All About Politics, Not Policy

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Democrats have effectively turned the issue of preexisting medical conditions into a political weapon with which to pound Republicans who don’t understand the policy issues any better than Democrats. 

In her opening statement at Judge Amy Coney Barrett’s Senate confirmation hearing, Senator Dianne Feinstein (D-CA) mentioned that some 130 million Americans have a preexisting condition, an estimate from the Centers for Medicare and Medicaid Services. The implication is that if the U.S. Supreme Court were to overturn the Affordable Care Act, more than a third of the population would likely be unable to obtain health coverage. 

One obvious question, which the feckless media never ask, is whether there were 130 million uninsured Americans before Obamacare became law? The answer is nowhere close. 

Neither Medicare nor Medicaid—which together cover about a third of the population—ever excluded someone with a preexisting condition. If you qualify for one of those programs, you get coverage. Period. 

About half of the population—workers and their dependents—have employer-provided health coverage. Employers cannot exclude an employee from the company health plan. Historically, they could impose a waiting period for a few months for a new employee. There could also be a “look back period,” in which a new employee with a major pre-existing condition might have to wait a few months before being covered. But the 1996 HIPPA law greatly limited even that practice. 

Thus a total of about 85 percent of the population had health coverage where pre-existing conditions played little or no role BEFORE OBAMACARE! 

But pre-ex could be a problem for some uninsured individuals. 

From 1995 through the mid-2000s, there was an average of about 40 million uninsured Americans. That number ticked up to the mid-40s when the 2007 recession began. For comparison, there were 27.9 million uninsured in 2018—in a much better economy—according to the Kaiser Family Foundation.

 About a third of the pre-Obamacare uninsured were children who were eligible for Medicaid but their parents didn’t enroll them. Perhaps another third of the uninsured either couldn’t afford or didn’t want to spend the money on health coverage. 

Only a small portion of the uninsured—usually thought to be in the 3 million to 4 million range—had a major preexisting condition and were either denied coverage or were charged significantly more than a standard premium. 

Furthermore, 35 states tried to address the pre-ex problem by creating their own state-run “high risk pool” that provided health coverage to individuals with preexisting conditions who couldn’t get coverage. Some of the high risk pools worked well and some didn’t. Fixing that problem on a national level with federal guidelines and federal funding would have been easy—and cheap. 

So, yes, there were uninsured Americans with preexisting conditions who wanted to buy coverage and couldn’t. That was a real problem for a small percentage of the population, but it was easily and affordably fixable. 

But pre-ex is no longer a discussion about how to fix a public policy problem. It’s about how to hammer a political opponent.

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