FORT WAYNE – An organization that supports the federal health care law says more than 1.5 million Hoosiers – including 80,500 residents of Allen County – will benefit from a provision requiring insurers to cover pre-existing medical conditions.
The non-profit, non-partisan Families USA said the numbers represent more than a quarter of the population younger than 65.
A critic of the report calls it blatantly false, saying it fails to exclude workers whose medical conditions are already covered by employer-provided group health insurance plans.
The pre-existing conditions provision of the Patient Protection and Affordable Care Act takes effect in 2014. The law already requires coverage for children with pre-existing conditions.
Families USA said in a study released this month that 26.5 percent of the under-65 population in Allen County and 27.4 percent statewide could have been denied coverage without the provision.
Thanks to the health care law, each and every Hoosier no longer has to worry about being discriminated against because of health status, Families USA said in its report.
The study doesn’t tell the whole story, said Robert Zirklebach, vice president of strategic communication for America’s Health Insurance Plans, a trade association and lobbyist representing health insurers.
The vast majority of people get their coverage through their employer, which is done on a guarantee issue basis, meaning that all employees are guaranteed coverage regardless of their medical history, Zirklebach said.
The focus of the health care reform debate was really on the individual insurance market, people purchasing coverage on their own, which is about 5 percent of the market, he said.
The American Enterprise Institute, a pro-business public policy organization, was more critical of the Families USA study.
As written, it is blatantly false, not just misleading. And it is deliberately done so. It’s propaganda, said Thomas Miller, a health care policy and regulation specialist for AEI.
Miller said because more than 90 percent of American workers are insured by employer-provided group health plans, Families USA is, trying to oversell a proposition with statistics that don’t exist in order to take a small problem and use it to leverage massive changes on other people who are doing pretty well under this system of protections against these risks.
Kim Bailey, research director for Families USA, said critics of the study, aren’t taking into account the full picture of what’s happening here.
They ignore the fact that workers change or lose jobs, she said.
Some people who have job-based health insurance today may lose their job tomorrow and may no longer have access to health insurance, Bailey said.
Without the Affordable Care Act, she said, those people could be denied coverage or charged exorbitant premiums in the individual insurance market because of pre-existing medical conditions.
People make decisions about their employment based upon the availability of health benefits, Bailey said. There’s a phenomenon known as job lock, where people will stay in their jobs to retain their health insurance for themselves and their families rather than going to work for a smaller firm that may not offer health insurance benefits.
She said high premiums or the threat of coverage denials in the individual insurance market can deter people with pre-existing medical conditions from starting their own businesses.
They’re making those employment decisions based upon their health benefits, not upon the right job, Bailey said.
69 illnesses studied
Families USA said its study looked at people younger than 65 who were diagnosed and treated in 2009 for 69 serious conditions that are commonly linked to coverage denials, including cancer, diabetes, heart disease, pulmonary disease, stroke, chemical dependency and psychotic disorders.
The study divided Indiana into 34 counties or regional clusters of counties. The percentage of those people who faced possible coverage denials ranged from 24.9 percent in Boone-Hamilton counties to 29.8 percent in eight counties in southwestern Indiana.
Three regional groupings that neighbor Allen County were home to 97,200 people who could have faced denials, or 27.5 percent of their under-65 population, according to Families USA.
The group’s national study found that 64.8 million under-65 Americans – or 24.9 percent of that age group – were at risk of insurance denials.
A poll conducted in March by CBS News and the New York Times found that 85 percent of Americans support requiring health insurers to cover pre-existing conditions.
There’s no disagreement that some people are falling through the cracks of our health care system because of pre-existing medical conditions, said Zirklebach, of America’s Health Insurance Plans. Our industry has long supported reforms to get everybody in the system to assure people with pre-existing conditions can get access to health care coverage.
The question, he said, is how do you do that in a way that insurance coverage is affordable and that it is going to be sustainable in the long run.