This week, Republicans in the House of Representatives are trying to find the votes needed to pass the American Health Care Act (AHCA), which would repeal the Affordable Care Act (ACA). A previous effort to pass this bill failed over the question of what to do with people with preexisting conditions. Right now, the ACA bars insurance companies from charging people more for coverage based on their health status. The current draft of the AHCA gives states the right to allow insurance companies to charge people with preexisting conditions more and cover less.
While inevitably many lawmakers are backing or opposing the AHCA on purely political grounds, it would be shortsighted to dismiss those on either side of this debate as just being “mean” or “stupid.” Instead, I would argue that what we’re seeing is an underlying difference in philosophy. Those who want the AHCA to pass find the cost for premiums too high and want to lower that cost, even if it means people with preexisting conditions might pay more. Those who oppose the AHCA believe it’s society’s duty to provide access to insurance and health care to people with preexisting conditions, even if it means higher average premiums.
But there is an ugly undercurrent of an idea shaping this debate – that people with preexisting conditions did something to deserve their fate, and should therefore pay more for their insurance. Rep. Mo Brooks (R-Alabama) more than hinted at this in a May 1st interview with Jake Tapper on CNN.
The AHCA, Rep. Brooks said, “will allow insurance companies to require people who have higher healthcare costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”
Let’s just state the obvious – there are many people with preexisting conditions who just won the sucky genetics lottery. You could make an argument that people with Type 1 diabetes should pay more for health care because they use it more, but you can’t make an argument that they should pay more because Type 1 diabetes was their fault.
All smart politicians have a built-in radar for realizing when their comments might sound too blunt, and Rep Brooks is no exception. He immediately added, “In fairness, a lot of people with preexisting conditions, they have those conditions through no fault of their own, and I think our society under those kinds of circumstances needs to help.”
Okay, how? How do we weed out the deserving with preexisting conditions from the undeserving? Even if we somehow wave a wand and say people with Type 1 diabetes have the “moral” type of pre-existing condition, what if their A1C scores are terrible? Do they not deserve society’s help then? Do they deserve help if they tried hard, but their A1C scores are poor anyway? How do we determine that? Do we have health police that will track how many times a day they test?
Rep. Brooks seemed to get internally flustered with this kind of thought exercise, enough so that his thoughts phased in and out of the space-time continuum with his closing remark on the subject: “It’s a very complicated question, and I’m sure over the years there will be different permutations of it, both in the past, and as we go forward.”
Great, Rep. Brooks, come back to me with legislation that addresses those questions once you figure it out. Until then, let’s steer clear of the “who deserves it” argument.
If you want to watch Rep. Brooks’ full interview with Jake Tapper, you can click here:
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