Tuesday, July 10, 2018

Field Report: Pre-existing conditions

Medical Insurance is a jobs issue.

The American health care system links health care to jobs, not citizenship. It hurts the job market and locks people into the wrong jobs.

Current Democratic messaging treats health care as a human right. The ascendent Republican position is to speak of it as a consumer good, like buying a cell phone or a car; you get what you pay for.

Greg Walden, back in early 2017 when he was doing Town Halls in the District, said repeatedly that he understood the importance of protecting the ability of people with pre-existing conditions to get affordable health insurance.

The issue of pre-existing conditions is not just a problem for the poor. Well-to-do people, including Republican donors, face the problem. A husband and wife might have done well running a business, or have well paying salaried jobs, and be ready to retire at age 58, but the wife might have had a breast cancer scare at age 50. They dare not retire and close their health insurance tied to their jobs or business because if they ever lost the insurance coverage they could never get it independently in the market. They could be wiped out financially. As a Financial Advisor for 30 years I encountered stories like this repeatedly.

That is a problem the Affordable Care Act addressed. 

Sticky labor mobility is a jobs issue. Labor is less mobile and flexible than would be optimal, so there are pockets of unemployment in an economy of full employment and there are people forced to work in the wrong job for them, blocking promotions for the young, creating inefficiencies.

Walden reversed himself on pre-existing conditions. GOP “repeal and replace” actions weakened that provision by taking away the funding mechanism. It may not hurt him politically. The problem affects people one at a time and privately, and under different circumstances and maladies.

I received a letter from a reader who described anindividual situation. There are millions of these instances.

Field Report: A case study from Portland, Oregon

A 65 year old man writes:
"I have a twenty nine year old talented artist daughter who is caught in the medical American situation of pre -existing medical condition. 

At age 27 she started vomiting repeatedly over a 15 day period. After waiting in emergency for 8 hours at a Portland hospital a MRI showed she had excess water on the brain. She was one in a million according to the doctor. No accident or drug use caused this. She was just that unlucky one in a million. 

She is an artist and doing pretty well, painting family portraits on commission. It is a small business. She has a gallery in Los Angeles that displays and sells her work. She would like to move to Los Angeles where more opportunities exist to sell and promote her art business, but medical health care is a problem. 

She is stuck. Her condition is being treated under the Oregon Health Plan, but moving to California means she pushes re-set on insurance, and with the watering down of protections for people with pre-existing conditions she may not be able to get insurance coverage at any price. Her condition makes health insurance important, but she is a bad risk. She is discovering she may not be able to leave the state of Oregon health plan she is currently on and move to California? Will her brain shunt she has need to be adjusted? 

The Trump administration is making the sick patients on health insurance less insurable in terms of insurance reimbursement for people with pre- existing conditions. It makes moving to another state more complicated, and probably impossible, for her. If she were a normal, healthy 29 year old woman this would be less of an issue, but unfortunately she is not. She had the bad luck to be that one in a million.

It seems unfair that pre existing medical conditions would lock people into living in a certain state or force them to abandon business or job opportunities, but that is how it works out."


  1. The insurance companies get the most revenue from the jobs based system. It's expensive and complicated to administer and politically easy to keep in place, since they can play a shell game to hide who is really paying for it, given that most people have jobs and attendant insurance as a "benefit". Regressive politicians wring their hands and shed crocodile tears over the unfairness, and avoid taking responsibility for "the market", but they could change the system easily.

  2. My son was born with a major medical issue. After insurance, his weekly medical costs alone exceeded what I earned from working full time. It was financially beneficial for me to quit my job and drive 10 hours a week to Portland where he could get free treatment at Shriner's hospital. When my husband lost his job, my sons treatment specific to that medical condition was still covered through Shriner's, but we could not even purchase health insurance for our son for all other issues because he was born with a pre-existing condition. I was so thankful when that problem was fixed so other families wouldn't have to go through what we went through. To see that unravel is so sad.


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