Monday, March 29, 2010

The Healthcare Hangover and the Reality of Universal Coverage

So the healthcare party is over--now we have to read the fine print. With the political equivalent of a hangover. Yes, the last year has been wild and raucous, but we ain't seen nothin' yet. We’re going to need a lot of coffee to get through the policy wrangles ahead--or maybe another drink. But in the meantime, we are going to continue stumbling our way toward some sort of universal coverage.

The New York Times headlines, “Coverage Now for Sick Children? Check Fine Print.” As reporter Robert Pear notes, President Obama expressed great confidence that his healthcare bill would force the coverage of pre-existing conditions. On March 19, Obama said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”

That was the promise. But the reality seems to be different. Pear quotes insurance lawyer William G. Schiffbauer: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.” Oops.

For their part, Democrats are mad: “The ink has not yet dried on the health care reform bill,” snaps Sen. Jay Rockefeller of West Virginia, “and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.

But one must wonder: If Schiffbauer and the insurance companies are correct in their assessment--that “the fine print differs from the larger political message,” as the Times’ Pear, who has been following healthcare for decades, seems to accept as true--then that difference must have been obvious ten days ago, been obvious a week ago, or a month ago, or a year ago.

This loophole, if that’s the right word, is supposed to close in January 2014. As the Times puts it, “Insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a ‘guaranteed issue’ requirement before then.” And that grace period, which could mean, of course, that everyone concerned has nearly four years to figure out some new loopholes.

But for the time being, we might ask: We the Democrats simply careless in the way that they wrote the bill they just passed? Or, perhaps more cynically, we might wonder: Did they deliberately leave the loopholes, to ease the bill’s passage? And now, faced with those loopholes, what are Democrats going to do for the next four years? Are they going to simply fulminate against the insurance companies (perhaps while collecting campaign contributions) or are they going to seek to rewrite the Obamacare legislation? If they do seek a rewrite, there will, of course, be a fight.

And then, of course, will come the question: Can the health insurance industry exist if the government mandates that everyone be covered for everything? There are some on the left who don't want the industry to exist, of course, because they want the government to run the whole of healthcare--it's called "single payer." But there are plenty of others who don't want the government to have that power--the Tea Partiers, and many others who are simply fearful of too much power in Washington. And so the political and economic battle is joined, now, and for many years to come.

Meanwhile, the heart-tugging stories continue to appear, and what we see is that neither the left nor the right seems interested in cutting back on the sort of heroic medicine that saves lives.

Over the weekend, ABC News headlined, “Family Learns Pre-Existing Conditions Apply at Birth/Newborn Was Denied Health Insurance Coverage Days After Life-Saving Surgery.” As ABC’s Lauren Cox and Lara Salahi report:

Houston Tracy, a 12-day-old boy, has already survived a rare birth defect, a feeding tube and open heart surgery. Now his family is waiting to see how the battle with an insurance company will fare. Last week, Houston's parents found out that the term “pre-existing condition” can apply the moment someone is born.

It seems that little Houston was born with “d-transposition of the great arteries,” meaning the primary aorta and pulmonary arteries are transposed where they should meet the heart. Houston was born on Monday, March 15, within days, doctors at Cook Children’s Medical Center had operated, saving his life. “In Houston's case he would not have survived had he not gotten the care,” Dr. Steve Muyskens, the pediatric cardiologist who treated Houston told ABC. “Most children with this [would] have a demise within days to months in life.”

We might pause, of course, to admire the Serious Medicine that went into saving this little boy’s life--his arteries fixed, Houston can look forward to a normal childhood. That's what matters most. For Houston's parents, the surgery is primary, the insurance is secondary.

And of course, in this generous country, people are always going to find ways to save the life of a newborn, if at all possible. (That's a picture of the baby above, who doesn't want to help?)

But now the plot thickens. As ABC also reports, just days after Houston’s operation, the Tracy family formally heard their son was denied health insurance by Blue Cross and Blue Shield of Texas. ABC adds, “The provision in the health insurance reform act that prohibits health insurance companies from denying coverage to children with a pre-existing condition will only take effect six months after the bill was signed into law.” But wait a second--the Times said not until January 2014. As noted, this stuff is complicated.

Yet interestingly, ABC tells us, the Tracy family did get insurance:

Doug Tracy said his family has found an alternative route to get his child coverage through the Texas Health Insurance Risk Pool, and the policy will only cost $277 a month -- $10 more than the premium on the policy he tried to take out for his son. However, he said he's confused since he will still have to apply through Blue Cross and Blue Shield of Texas if he goes through the Texas Health Insurance Risk Pool.

So we might wonder--what sort of shell game is going on here? The Tracy family can’t get private insurance, so they get public insurance, administered, it seems, by a private company. Indeed, it's interesting that such a program as the Texas Health Insurance Risk Pool exists in the home state of Gov, Rick Perry and so many Tea-Partying opponents of Obamacare. Yes, they opposed Obamacare, but do they also oppose the system that brought the Tracy family its health coverage?

Maybe this is the way it has to be. For their part, Democrats wanted a bill, even if it didn't so what they said it would do, at least not yet. And for their part, Republicans oppose Obamacare, even if they seem to quietly support programs that do much the same thing.

The really important thing, as we have seen, is that Houston Tracy got his operation; his little life has been saved. Now the adults will have to figure out the financing mechanism.

But what seems clear is this: We are going to end up covering everyone, out of one “pot” or another. The only question is how.

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