Medical insurance is a gamble and some people are a bad bet. There are those who receive their black marks while still in the cradle, diagnosed with epilepsy, Type 1 diabetes, cerebral palsy, a heart defect or some other condition. Even with high premiums, those babies will cost insurance companies money year after year.
Others have time — often decades — before they join the list of unprofitables, but they’ll get there eventually. Aging is the universal pre-existing condition, after all. Then there’s the lifetime’s worth of potentially high-ticket medical events or diagnoses along the way — pregnancy, injury, cancer, asthma, mental illness, arthritis, Lyme disease and heart disease among them.
From a business perspective, which is what medical insurance is after all, it doesn’t make sense to enroll individuals who routinely rack up high medical bills — at least not at a rate that the vast majority of Americans could afford to pay. The median 2017 household income was $60,336, according to U.S. Census statistics. Diabetics incur average annual medical expenses of $16,752, of which about $9,601 is attributed to the disease, reports the American Diabetes Association. Average cancer treatment runs in the $150,000 range, according to AARP.
Studies by the Fred Hutchinson Cancer Center in Seattle found that cancer patients are 2½ times more likely to declare bankruptcy than people without cancer. And those patients who go bankrupt are 80 percent more likely to die from the disease than other cancer patients. Being sick costs a lot of money and financial worries add stress at an already intensely stressful time.
According to an analysis by the Department of Health and Human Services, 50 million to 129 million non-elderly Americans have some type of pre-existing health condition. Under the Affordable Care Act, they cannot be denied health insurance, but the ACA’s future is far from certain. The individual mandate, requiring people without health insurance to buy it or face penalties, aimed to decrease the number of uninsured and rein in premiums by bringing more healthy, low-risk people onto the insurance rolls. Not surprisingly, the mandate was widely unpopular. Many uninsured Americans were unwilling or unable to pay for premiums on the new markets. Congress in 2017 reduced the individual mandate penalty to $0 effective this year. Last month, the Trump administration asked a federal court to strike down the entire Affordable Care Act.
Protections for pre-existing conditions must be preserved. To that end, U.S. Rep. Jared Golden (D-Maine) has co-sponsored “The Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019.” Unlike the individual mandate, protections for pre-existing conditions have been popular with the American public. Lawmakers must remember that and the millions of people who rely on those protections for access to affordable health care. We could do with less political posturing and more problem-solving on this and so many other issues.