Home / News / Article


May 5 2017

Not every health problem is a pre-existing condition

via Washington Examiner
by Hadley Heath

Several media outlets are seizing on a new narrative: They're saying the House Republican American Health Care Act that just passed the House would allow insurance companies to treat rape and domestic abuse as pre-existing conditions.

The narrative isn't exactly true, but it points to a very important discussion in the world of health policy right now: What does it mean to have a "pre-existing condition" and how should our laws handle this issue?

Supporters of the Affordable Care Act, or Obamacare, have intentionally confounded two things: a condition that makes someone "uninsurable" (another buzzword!) and a factor that indicates someone is likely to have higher than average health insurance expenses.

This is why the Left and Right disagree so often about the scope of the problem of pre-existing conditions. The Right wants to focus on only those people who struggled to obtain insurance due to their pre-existing conditions. The Left, in an effort to make Obamacare's benefits seem applicable to more people, focuses on any risk factors that could contribute to higher insurance costs and calls those factors "pre-existing conditions."

For example, you may have heard that before Obamacare, being female was a "pre-existing condition." No. Before Obamacare, women often paid more than men for health insurance because women generally consume more healthcare than men. In other words, insurance companies charged women more because they paid more claims for women, and insurers tried to offer premiums that reflected claim costs. This is the same dynamic that's at work in other types of insurance, like auto, except that it's men and younger people who tend to pay more because they tend to have more expensive accidents in vehicles.

While this practice in health insurance might seem unfair to women or any higher-risk group, it actually helped balance insurance pools. Men don't want to pay more for insurance than they think they'll get out of it, and if we raise their premiums to match women's, some men are going to walk away from the offer, choosing to go uninsured instead. That means the pool of insured will be less healthy and more costly, pushing premiums even higher.

That's exactly what happened with Obamacare. Obamacare made it so insurers basically had to charge everyone similar premiums, regardless of many risk factors. Predictably, younger, healthier (often male) people said no thanks. Cue the death spiral.

The American Health Care Act won't repeal the prohibition on gender-based pricing in insurance, but it will allow states to get waivers from "community rating," or the prohibition on all health-related risk-based pricing. This policy hopes to allow some states to stabilize their insurance markets by letting insurers offer lower prices to healthy people in an effort to get them to buy in.

The wailing and gnashing of teeth from the Left is overwhelming. In an effort to grasp for the most egregious possible outcome, CNN and other media outlets are now claiming that this could result in some insurance companies treating rape or abuse as a risk factor or "pre-existing condition" that would result in a higher premium or even the denial of insurance.

Yet this is really a red herring in the debate about how our insurance markets ought to operate. I could see how someone might think that insurers could flag rape or abuse as a risk factor, as survivors might have health needs down the road associated with the traumatic, heinous crimes committed against them. But everyone – including the insurance industry – agrees that survivors shouldn't be discriminated against for insurance. That's why the National Association of Insurance Companies issues guidance to their members not to use rape or domestic abuse as risk factors, and the industry follows this guidance. Furthermore, the practice is outlawed in all but a few states. These experiences certainly aren't "pre-existing conditions."

At the Reason blog, Elizabeth Nolan Brown digs up a 2009 PolitiFact investigation showing no evidence of insurers charging higher premiums or denying coverage to survivors, and she points out important shortcomings in the few stories highlighted by CNN that were meant to serve as evidence.

It's unfortunate that so much of the fear-mongering about the Republican health plan is aimed at women. It's not just the claims about rape or domestic violence, but there are other misguided articles claiming that pregnancy, c-sections, or post-partum depression will qualify as pre-existing conditions. These are meant to make women feel like they won't be able to get coverage, but that's not reality.

In fact, returning to a situation in which insurers can actually offer tailored health insurance plans and take health factors into account will come with benefits for states who would pursue such waivers. Some seemed to want to celebrate Obamacare because men's premiums were the same as women's, but ignored that prices went through the roof for both. Absent these regulations prices will go down for both women and men, and there are special provisions designed to help make sure that those who face higher costs and health conditions will get the support they need.

The bottom line is that we can all rest assured that the practice of denying insurance coverage to women simply because they are survivors of rape or abuse isn't about to come into vogue, regardless of what type of health reform ultimately becomes law. There are serious debates to be had about risk, insurance, and how to pay for healthcare. Scare tactics – like pointing to rape and abuse survivors as potential victims of some boogeyman "war on women" – don't contribute anything to these debates but unnecessary fear and misinformation.

Independent Women’s Forum’s mission is to improve the lives of Americans by increasing the number of women who value free markets and personal liberty. Sister organization of Independent Women’s Voice.
Follow us