Preexisting Confusion

One of the favorite political tactics of the Left is to paint opponents of entitlements as hard-hearted.  “They only care about themselves,” says the Left.  Or, “they aren’t compassionate.”

Today Republican members are bringing a vote to repeal the health reform law to the House floor.  The debate will be painted like this: Republicans are concerned about money.  They don’t want the health law to hurt our economy (by “killing” jobs), and they don’t like that it will cost so much in government spending (funded by new taxes).  On the other side, Democrats just want to provide for everyone, no matter the cost, because they are sweet and kind and compassionate. 

This depiction of the debate is flawed (or at least, incomplete).  Some supporters of the health law are actually really sweet people, I’m sure.  But the concerns of opponents go far beyond money.  Opponents of the law are concerned with the quality of the health care system – not just for the rich – but for everyone. 

People who are already on Medicaid know that often it is difficult to get treatment or find a doctor willing to work at the government’s low reimbursement level.  Do we want to put more people in this situation, by expanding Medicaid? 

People who have preexisting conditions know that the health insurance market is a tough place for them.  I met a woman at Bible study with a preexisting condition, and when she told me how much she pays for health insurance, I almost choked.  If I were in her position, those premiums would eat up my life savings in months.  The provision in the Affordable Care Act that requires insurers to do business with people in this situation is popular with Americans.  We don’t want to see sick people suffer.  So the White House is going to take advantage of the popularity of this part of the law, in an attempt to play on the heartstrings of Americans:

The Obama administration released a report Tuesday that estimates that as many as 129 million Americans under age 65 have preexisting medical conditions that could make it more difficult for them to obtain health coverage.

The analysis prepared by the Department of Health and Human Services marks an attempt to quantify how many across the country would be affected if the law, the Affordable Care Act, were repealed — and is part of the administration’s accelerating strategy to defend the legislation. (From the L.A. Times, emphasis mine)

That’s extreme – 129 million Americans under 65 have a preexisting condition.  But Michael Cannon at the Cato Institute also read the HHS study, and offers these counterpoints:

An HHS survey found that in 2001, only 1 percent of Americans had ever been denied health insurance.


Economists Mark Pauly and Len Nichols write, “the fraction of nonelderly uninsured persons…who would be rated as actuarially uninsurable is generally estimated to be very small, less than 1 percent of the population.”


RAND health economist Susan Marquis and her colleagues find that in markets that do not impose ObamaCare-style government price controls on health insurance, such as California’s individual market, ‘‘a large number of people with health problems do obtain coverage…Our analysis confirms earlier studies’ findings that there is considerable risk pooling in the individual market and that high risks are not charged premiums that fully reflect their higher risk.”


It is true that insurers charge higher premiums to many people with pre-existing conditions – and it is crucial that they have the freedom to do so.  Risk-based premiums create virtuous incentives for people to buy insurance while they are healthy and to be cost-conscious consumers.  They also encourage insurers to develop innovative products that protect against the risk of higher premiums.  The real problem here is that the government has created an employment-based health insurance system that denies consumers the protections that unregulated markets already provide, as well as additional protections that insurers would develop absent this government intervention.


ObamaCare’s health-insurance price controls will encourage insurers to deny care to the very sick people those price controls are intended to help.

I don’t pretend to know what it’s like to be marginalized by society.  I don’t have a preexisting condition, and I’ve never lacked food or a roof over my head.  But when the White House exaggerates the number of people in a difficult situation, they actually disrespect the plight of those truly in need.

Opponents of the Affordable Care Act are not just concerned about money.  They are concerned about people too.  Repeal of this horrendous law would be a good first step toward true reform – reform that gives people of all backgrounds more access and more freedom.