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Before Obamacare: what about those pre-existing conditions?

Before Obamacare: what about those pre-existing conditions?

Complaints about lack of access to insurance for preexisting conditions may be overstated

The recent spate of articles about how wonderful it is that this person or that person was able to quit a nasty job (or not take on a nasty job they thought they’d have to get) because of Obamacare includes this one by Diana Reese of Kansas:

Had the ACA not become law, I would have considered a job as a “lunch lady” in one of the nearby elementary schools — just to get health insurance.

My inspiration was an out-of-work accountant I met at a social event a couple of years ago. When asked what he did for a living, he laughed and said, “lunch lady.” Then he explained that he’d been laid off during the recession, and though his wife worked at a job she loved, she had no benefits. So he took a job at his children’s school, working a few hours a day to qualify for health insurance for his family…

Because of my own pre-existing condition, I couldn’t buy health insurance — at any price — before the ACA.

She goes on to add that her husband had been employed and she was actually covered under his health insurance, but they both knew the coverage would end because it was a time-limited contract position. At that point, since she was uninsurable any other way, she was considering that lunch lady route.

Only thing is that Kansas was a state that had a high-risk pool even prior to Obamacare, as did most states.

The following excerpt is taken from a piece on the subject that appeared in April of 2010 and describes the high-risk pool in Kansas right around the time that Obamacare was passed, before Obamacare’s provisions had ever been implemented:

Kansas is among about 35 states that already have a high-risk pool…High-risk pools provide health insurance for people whose medical history makes it difficult or impossible for them to otherwise find affordable coverage.

In Kansas, about 1,800 people are enrolled in the state’s existing plan, which is managed by the Kansas Health Insurance Association…

Kansas law governing the existing high-risk pool here allows for premiums up 150 percent the cost of a standard, non-group policy, though that has been held to 128 percent by decision of the risk-pool’s governing board.

So there was a high-risk pool in Kansas that covered people with pre-existing conditions. It was somewhat more expensive than regular insurance, to be sure, but not so very very much more expensive. Many pre-Obamacare state high-risk pools also provided subsidies for those with low incomes.

So, if Diana Reese had lived in Kansas when all of her insurance woes (or prospective insurance woes) occurred—and the focus on Kansas in her article implies that she did—then she could have purchased insurance, and the price would not have been so extraordinarily much higher than standard insurance either; the premium price would have been capped at 128% of a healthy person’s premium cost.

If you look at the chart about two-thirds down this page, you’ll see that 35 states ran high-risk pools prior to Obamacare, and most of them had been in operation for many many years (for example, Kansas had started its high-risk pool in 1993).

The 15 states that didn’t have high-risk pools didn’t necessarily leave their high-risk individual health insurance customers in the lurch, either. Some were guaranteed issue states, which meant that pre-existing conditions could not be excluded at all: New Jersey, New York, Maine, Massachusetts, and Vermont had straight guaranteed issue, with Ohio, Oregon, Rhode Island, and Idaho having guaranteed issue with some restrictions involving previous continuous coverage.

There were indeed some states where people were in a situation much like the one Reese describes, but it would appear that Reese (if she had lived in Kansas immediately prior to Obamacare) would not have been considered one of those people, even potentially.

So I really, really wonder what Reese is talking about when she said she could not get health insurance “at any price.” Did she live in some other state? Did the Kansas high-risk pool function in some unusual manner that excluded her? Or did she just assume she couldn’t get coverage rather than actually checking it out?

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]


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About a year ago, I did a Google search (I was still using Google then). I found there is…or there was…a thriving niche market for “pre-existing condition insurance”.

I call it “writing without doing the underlying reading.” Some people call it “lying.”

Yep, Texas had a risk pool, too. But of course they canceled all the policies (some 26,000+) because they “were no longer needed due to Obamacare”.

*Thank you* for this post, and please keep making this point.

The lie that people with pre-existing conditions were uninsurable before Obamacare is one of the great lies that were repeated over and over again to get this monstrous bill passed, and that are still being repeated to keep it from being repealed.

I’ll never understand how Democrats and the leftwing media get away with telling and retelling this lie. *Where* were the Republicans in 2009 and 2010? Where are they *now*? They should have been (and still should be) shouting from the rooftops 24/7 to show that the Left’s claims about pre-existing conditions are false.

Have none of them ever heard of states’ high-risk pools, about which neo-neocon admirably reminds us above?

Or of HIPAA, the law of the land since 1996? To this day, the federal Dept. of Labor website *still* brags that HIPAA (a) “limits the ability of a new employer plan to exclude coverage for preexisting conditions”, and (b) “guarantees” that many people in the individual market with pre-existing conditions “will have access to, and can renew, individual health insurance policies.” See . So the source material we need to expose this “great lie” has always been readily available to us.

If it’s true that “A lie repeated often enough becomes the truth”, then let’s *also* hope that “A false ‘truth’ exposed often enough as a lie becomes a lie”.

    janitor in reply to JPL17. | February 13, 2014 at 10:25 am

    And of course the important issue isn’t whether someone can get “health insurance” but whether someone can get “medical care”.

      Radegunda in reply to janitor. | February 13, 2014 at 11:08 am

      The “care” part is obviously pretty low on the Democrats’ priority list. Many of them have been ridiculing people who are finding that their Democrat-approved policies don’t cover the treatment that their former (“substandard”) policies did.

You mean Obama lied about Obamacare? I ‘m shocked!

Diana wrote essentially this same article for the WP last November. (Life must be good for freelancers when you can get paid a second time for recycled, three-month old material.)

The “No insurance at any price” line is her favorite catch phrase of hers.

Here’s how she addresses a challenge in the comments about availabity (my emphasis):

“I went through three different insurance brokers and personally contacted at least half-a-dozen insurance companies before our COBRA coverage was scheduled to run out. Everyone turned me down; the brokers said I would not be able to purchase from a private company. Kansas did have a program for those who had been WITHOUT insurance for at least six months, but I did not want to take that risk. Fortunately, my husband found a contract job with benefits.”

She shows up in the comments of the latest article too. When asked again about clarifying the “nothing available at any price” assertion? Crickets.

    IrateNate in reply to BlueOx. | February 13, 2014 at 8:24 pm

    Remember that “truth” is whatever you can make people believe it is. The left is quite adept at creating truth.

It’s somewhat reminiscent of the gay marriage proponents who were always citing stories of gays who couldn’t always visit their partners in the hospital because they weren’t married — as if there was no other way of dealing with that one situation but to permit SSM.

    Radegunda in reply to Conrad. | February 13, 2014 at 11:12 am

    Awhile back, I visited someone (who had almost no family) in the ICU three times before noticing a sign saying that only close relatives (or people with some other kind of special approved status) were permitted in the rooms. Not one of the staff ever asked who I was or expressed any objections to my being there.

Stage One thinking is a pre-existing condition of Democrats.

They never think beyond Stage One and look at prexisting reality or toward the future’s sure-to-be uninteneded consequences. They look for votes and only votes.

The Dems & Obama rushed to get the healtcare legacy-vote passed w/o reading it. They wanted to insure their fame and tenure within DC. Instead they enabled their politicopathology.

    …and harmed millions of Americans in doing so.

    They continue in denial about the unsafe, untenable, Julia-ized website and the worthiness of such a moronic health care scheme.

    Obamawreck is a moronic squeeze for all Americans.

    … just as they praise themselves for once again lifting the debt limit unconditionally. They tell the public that it’s the responsible thing to do, that it’s “clean” (and the media parrot them shamelessly).

    Not one Democrat seems to care about the long-term consequences of a debt that exceeds the GDP, not counting unfunded liabilities. For Dems, it’s enough to get keep expanding their one power and keep buying votes for Dems.

Did you also know that Mrs. Sebelius was the Kansas Insurance Commissioner beginning in 1995? And held the position for two terms?

Cherry-picking run amok. Like most of your ACA stories. Did anyone try to price any of the so-called pre-existing condition plans that were available before the ACA mandated it? I did. $1,200/mo for an individual….

    JPL17 in reply to cresist. | February 13, 2014 at 1:52 pm

    Actually, the article DOES compare the cost of insurance in the assigned-risk pool to the cost of regular insurance, and even cites state law “capping” how much the former may legally exceed the former.

    It might improve the quality of your comments if you actually READ the frickin’ article before snarking on it.

I am shocked, shocked I tell you, that Democrats played fast and loose with the facts simply in order to get what they wanted.


As I wrote in the post, in Kansas the price of a policy in the high-risk pool was capped at 128% of the price for individual insurance for a healthy individual. Many of the states with high-risk pools had such caps.

How do I know about this, besides reading about it? I don’t live in Kansas, but I bought individual health insurance in a high-risk pool in a different state for many many years. I paid much the same as I had before, the only difference being that I had a higher deductible than before.

I would wager that Ms. Reese is misrepresenting her situation in Kansas when she says could not get insurance “at any price.” In fact, she could get it at 128% of the price she would have paid without a pre-existing condition.

    Do you have any idea what she’s talking about when she says, “Kansas did have a program for those who had been WITHOUT insurance for at least six months” from my comment above?

There is a free-market solution to this for responsible folks, but it’s hard to get to there from here. What would work are plans that cover you your whole life, much like life insurance.

My dad worked for Prudential from the 50’s until about 2000. Pru used to sell health plans, but got out of it when the HMO insanity took over. I grew up with whole life policies that I still own. Insured parents could buy policies on kids — guaranteed with no medical exam. The policies had a feature that allowed additional coverage to be purchased without medical exams as the kids got older.

This could work for health coverage, too. How about a policy for adults that gives guaranteed coverage for newborns with options for kids to continue the policy when they become adults? (Do such policies exist now?) Pre-existing conditions are thereby covered. If policies like that caught on, the competition of insurance companies would make policies affordable. Again, though, how do we get there from here?

Blue Ox:

Reese may have been talking about the fact that if a person had had insurance (“credible” insurance, however that was defined, and I believe it was defined more broadly prior to Obamacare) during the last 6 months, that person could not be frozen out of buying insurance on the individual market because of a pre-existing condition.

That would have meant that Reese could indeed have bought individual insurance on the regular market as long as she didn’t let too much time lapse between her previous coverage and her new coverage. It might have cost more, but she could have bought it.

High-risk pools generally existed to cover people who could not otherwise get insurance. That meant, by definition, people who had been without insurance for 6 months or over (without “continuous coverage,” that is). However, just because high-risk pools served that group, it doesn’t mean other people had no access to them. For example, in the states I’m most familiar with, you could get coverage from the high-risk pool (and this is what happened to me, by the way) if the individual policy premium price you were quoted was higher than a certain percentage of the usual price. I was quoted a fairly high price because of my pre-existing condition, and all I had to do was document that (or document being turned down entirely for insurance) and I was eligible for the high-risk pool.

As far as I know, that’s the way it worked in a lot of states. Nothing I have read about Kansas indicates it wouldn’t have worked that way there, as well. So in other words, Reese would probably either have been eligible for individual insurance (more expensive, but available) or for the high-risk pool, or for both.

Back in the mid-90’s, I was involved with Illinois’ High Risk Plan. If I can recall, approximately 30 states sponsored subsidized insurance plans for high risk individuals at that time. Covering so- called “uninsurables” was quite common prior to ObamaCare and is nothing new.