U.S. Rep. Bruce Poliquin provided a critical vote to pass a new health care bill that guts protections for people with pre-existing conditions. It allows insurance companies to charge older patients five times more than younger ones. It eviscerates Medicaid.
Courtesy of Poliquin, we are back to the bad old days when sick patients were playthings of insurance companies. How bad will it get? How much will we now pay? How many millions will lose insurance?
We don’t precisely know yet because Poliquin and his colleagues couldn’t wait to get analysis from the Congressional Budget Office to find out. All he knows — and he has “ studied this issue carefully” — is that nothing could be worse than the Affordable Care Act.
We already know more than that. Health care economists Sam Berger and Emily Gee estimate that for pre-existing conditions, insurers would impose premium surcharges under the American Health Care Act: $5,600 for diabetes, $17,300 for pregnancy, $28,660 for breast or colon cancer, $57,660 for a heart attack, $142,650 for metastatic cancer. Of course, you can still keep your insurance, as long as you pay these new premiums. This is called having “access” to health care.
Poliquin reassures that those who have pre-existing conditions needn’t be concerned. Unless, it turns out, a state opts to establish a “high risk” pool. In that case insurers in that state would be free to charge whatever they please based on a person’s health status.
Not to worry: Companies may discriminate in this way only if patients incur a lapse in coverage. And that might only happen if a patient can’t pay their premium because — wait for it — they’re sick and their medical bills are overwhelming. Or if they have to pay their rent first or their heat or electric or food bill. Or if they lose their job. It’s estimated that 30 million Americans “irresponsibly” let their coverage lapse each year for such reasons.
Here is an inconvenient fact about these high-risk pools: They are not new and have been studied extensively. They have never been funded at the level that can remotely compensate the additional costs for people with pre-existing conditions. It was their widespread failure in the first place that prompted the Affordable Care Act’s ironclad guarantee that insurance companies be required to affordably insure people who had medical conditions.
It’s not that complicated. Sick patients are super expensive to care for, by factors of five or 10 or 20. For that reason, high risk pools envisioned by the AHCA would be inadequate by roughly 20 billion dollars annually. To obtain affordable premiums, patients in Maine would need $129 million more each year than the bill provides.
Remember the policy price of $57,660 for a heart attack? A high-risk pool would decrease that premium by $570, to $57,090. Or from $28,660 to $28,230 for breast cancer. Or $142,650 down to $140,510 for incurable malignancies. As the bill Poliquin helped drag across the finish line is written, these pools provide not protection but a license to price gouge.
Most of us can’t afford to buy into self-serving health care fantasies that provide politicians with political cover. They include the 266,000 Mainers in Poliquin’s district who have a pre-existing condition and are too young for Medicare. As an oncology physician assistant for 30 years, I can attest that seriously ill patients have enough trouble without contending with the devastating consequences of being uninsured or underinsured.
These are the consequences that Poliquin owns. Before the vote, he said that he would “support the repeal of the Obama Care law if the replacement retains coverage for pre-existing health conditions.” Then President Donald Trump and House Speaker Paul Ryan offered him a ploy to disavow his own words: a magical $8 billion amendment for a high risk pool that added just 6 percent to the funds states would already receive.
It was a fig leaf he chose to wear. I’d advise him to not to throw it away. Because it’s all he may be wearing on Election Day 2018. On that cold day in November, Mainers who will also be suffering from exposure — to unaffordable and inadequate health insurance — will know why. And they will know who threw them under the bus.
Dennis Chinoy of Bangor is retired physician assistant.