As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care. This is a fundamental precept, morally and pragmatically sound, that should be honored by all who seek to transform for the better America’s flawed system of health care delivery.
Regrettably, since its passage in 2010, the Affordable Care Act (ACA) has had the net general effect of raising the cost of health insurance while reducing the quality and variety of the services that insurance covers. This is the opposite of what was intended — but the suffering engendered thereby is real and painful.
The best-case remedy would be to repeal the ACA completely and replace it with a much simpler, more targeted set of common-sense interventions to empower consumers and ensure their access to insurance that is affordable, portable, and tailored to their needs.
President Trump has set this goal and has repeatedly exhorted the Republican Congress to pass a new law accordingly. The lack of a governing majority in the Senate, which under current filibuster rules requires 60 votes to pass most pieces of legislation, is the single logistical factor most responsible for Congress’s failure in this regard.
What Congress has managed to do, in the Tax Cuts and Jobs Act, is repeal the individual mandate, thereby lifting one of the distinctive burdens imposed by the ACA — and, further, laying the groundwork for a fresh legal challenge to it. In February, a group of 19 state attorneys general joined Texas in suing the federal government, charging that without the individual mandate, which had been the basis for the Supreme Court’s finding of constitutionality in 2012, the entire law can be considered unconstitutional.
In predictable response, the ACA’s supporters have raised the ugly specter of harm to people with pre-existing conditions — certain types of health problems that people have had prior to seeking to obtain health insurance.
The emotional impact of arguments surrounding pre-existing conditions, based on troubling accounts of Americans with life-threatening problems who cannot obtain insurance coverage, is understandably profound. Elected officials on both sides of the aisle respond to the outrage and anguish by pledging not to change the ACA’s requirements regarding pre-existing conditions. In so doing, though, they are effectively assuring that the harms the ACA does will continue.
Before the ACA, having pre-existing conditions did raise the cost of health insurance — sometimes to unaffordable levels — for some Americans, and the key word here is “some.” Their numbers were very few relative to our population of over 300 million, and we can make a rough estimate of less than 120,000 — that is, well under 4 people per 10,000 nationwide — based on participation in a program designed to insure those with pre-existing conditions in the early phase of the ACA.
Should we help these fellow citizens in need? Yes.
Can we help these fellow citizens in need without the ACA? Yes!
In fact, we could help people with pre-existing conditions far better if we weren’t struggling under the burdens that the ACA has imposed on us as individuals and as a society.
The best way to help people with pre-existing conditions is to:
- Eliminate the requirements in the ACA that force millions of Americans to pay far more than they need to for their health insurance;
- Allow us instead to pay far less for insurance policies that actually meet our needs and budgets; and
- Allow states to fund, typically through a small surcharge on regular health insurance policies or tax revenues, “high-risk” pools dedicated to the special needs of our fellow citizens with pre-existing conditions and other challenges that make their care more costly than can readily be accommodated in the more routine marketplace.
This solution has been proven to work in most states pre-ACA, and with a bit of federal help it can work in every state — which is what the ACA was meant to accomplish in the first place, but massively and unsustainably failed to do.
For our nation’s health care, the Affordable Care Act creates a dangerous pre-existing condition all its own — and now is the time to resolve it.
The Honorable Nan Hayworth, M.D., represented the 19th District of New York in the 112th Congress. She is a member of the board of directors of the Independent Women’s Forum and the chairman of the board of directors of ConservAmerica.