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Fact Check: What the Democrats Won’t Tell You About Pre-Existing Conditions

January 18, 2011

The Obama Administration today released a “report” claiming that anywhere from 50 million to 129 million non-elderly Americans “could be denied affordable coverage” if the Democrats’ health care law is repealed.  With 17 million non-elderly individuals uninsured, the “report” attempts to mislead the public that up to 129 million Americans are at risk of losing their health insurance, which is simply untrue.  But, let’s get the facts straight – it doesn’t take a one trillion dollar, 2,000 page government-takeover of our health care system to assure protections for those with pre-existing conditions.  Despite the report’s misleading claims and mischaracterizations, consider the facts: 

  • Even without the Democrats’ health care overhaul, most Americans with pre-existing conditions already have protections because they receive health insurance through an employer.  This means that if their employer offers coverage, they are guaranteed an offer of health coverage under the Health Insurance Portability and Accountability Act (HIPAA) regardless of their health status or history.  HIPAA ensures that employers cannot deny the offer of health insurance to an employee on the basis of a pre-existing condition.  Currently, 61 percent of Americans under the age of 65 receive coverage through an employer. (CBO: Key Issues in Analyzing Major Health Insurance Proposals).
  • An additional 24 percent of non-elderly Americans receive coverage through Medicare, Medicaid, or another government program and cannot be denied access to coverage because of a pre-existing condition. (CBO: Key Issues in Analyzing Major Health Insurance Proposals)
  • Amongst the uninsured (17 percent of the non-elderly population), 42 percent are eligible for guaranteed coverage regardless of pre-existing condition but choose not to enroll.  For example, 12 percent of the uninsured are eligible for Medicaid, 6 percent are eligible for Medicaid and employer-sponsored insurance, and another 24 percent have an offer of employer-sponsored insurance.  (CBO: Key Issues in Analyzing Major Health Insurance Proposals)
  • This leaves less than 14 percent of non-elderly Americans who can be denied health insurance on the basis of a pre-existing condition:  the remaining uninsured that do not have an offer of employer-based coverage and the 4 percent that purchase coverage on their own.  (CBO: Key Issues in Analyzing Major Health Insurance Proposals).  Keep in mind that many of these individuals may not have a pre-existing condition (like the healthy 25-year old who chooses not to buy coverage).  This is a far cry from the 50 percent claim made today by the Obama Administration.

Still, providing individuals with a pre-existing condition access to affordable coverage is a common-sense goal.  It is not solely a Democrat goal or a Republican goal – it is a goal of all who want to make sure that patients have much-needed protections – regardless of their health condition or how they buy coverage.

But the Democrats’ scare tactics beg the question:  Did Democrats have to spend over one trillion dollars, slash Medicare, and raise taxes to address this problem in their 2,000 page bill?  The answer: No.

There is a better way.  The common sense alternative offered by House Republicans last Congress would have provided access to affordable health coverage for all Americans, including those with pre-existing conditions, by:

  • Making it illegal for an insurance company to deny coverage to someone with prior continuous coverage on the basis of a pre-existing condition;
  • Making it illegal for an insurance company to cancel a policy except in cases of fraud;  
  • Ending lifetime and annual benefit caps; 
  • Fully-funding high-risk pools and reinsurance programs and, unlike the Democrats’ law, prohibiting wait lists to enroll in such programs; and
  • Reducing premiums for millions of families, making them $3,200 cheaper than under the Democrats’ health care law.

And, unlike the Democrats’ health care law, the GOP alternative lowered premiums in every market and provided affordable coverage for those with pre-existing conditions without raising taxes or cutting Medicare. 

Repeal of the Democrats’ health care law is the first step, but not the last.  Republicans will continue to work to develop solutions that ensure every American has access to coverage that meets their health care needs.