Essential Health Benefits: Office Visit With Rep. McHenry Staff
Two of our members recently met with Roger Kumpf, Rep. Patrick McHenry’s staff member at his Black Mountain office, to present their concerns about the importance of essential health benefits and coverage for pre-existing conditions. Their main points were summarized in a leave-behind MEMO, which is quoted in full below.
The results? The staffer read the document carefully and engaged in friendly discussion of the issues. He assured them that the leave-behind document would be sent electronically sent to Rep. McHenry’s office in D.C.
“No way to tell if it will change any minds,” said Katie Winchell, leader of the Healthcare Team’s ACA Focus Group and author of the document, “but I included some history of the types of pre-existing conditions that were not covered before the ACA, as well as some medications that were declined for coverage, from research posted on the Kaiser Family Foundation website. He seemed surprised by some of that. I also explained the ‘Family Glitch,’ as an example of something that could be improved in the ACA, to cover more people at a lower cost, if it were improved rather than repealed. It was a mostly pleasant visit, and I know we would be welcome to return, should the need arise.”
MEMO
“When people discuss how to improve the health insurance programs, I’ve often heard that if people were allowed to pick what coverage they wanted, insurance would be cheaper. In fact, actuaries for insurance companies will tell you that they study the population that an insurance company will be covering and they know that men don’t use maternity coverage, 60-year-old women probably don’t either, and it’s unlikely that a 20-year-old will need a hip replacement. They know what percentage of that particular population will be likely to develop diabetes, cancer, and other chronic diseases. Then the premiums are set to cover the likely coverages needed for that population.
“So, having men opt out of maternity coverage won’t make any difference. That has already been factored in. And it goes against what insurance is supposed to do for people—to encourage them not to try to guess what coverages they need and don’t need. Who really knows at what age they are at risk for a stroke or depression, for example. It’s much better to cover everyone for whatever might happen, and depend on the expertise of the actuaries to know how to predict the cost of that coverage.
“That is why they are called ‘Essential Health Benefits,’ because they are proven to reduce health care costs over time. Preventive care has been shown time and time again to be the way to keep health care costs down, by discovering and treating problems while they are still small, before there are major symptoms and often serious and costly consequences. If people skip the check-ups, and don’t get their preventive care, they may save a little money in the short term, but they risk having much worse medical problems and higher health care costs down the road. And we all know that folks who don’t have adequate insurance coverage end up going to the Emergency Room when their health deteriorates—the site of the most expensive health care available, with little or no follow-up to keep them healthy after they are treated.
“EXAMPLES:
- “Skin Cancer on the face (basal cell carcinoma), a fairly harmless type of cancer, can often be diagnosed when it is small, and treated with an in-office 15-minute procedure. If left to grow, it can eventually enter the brain and be very serious. Many people would probably not opt for coverage for plastic surgery, but that is exactly the specialist who treats skin cancer of the face, to prevent it from entering the brain.
- “I worked with a middle aged woman who had suffered several Strokes, although the majority of people would think only the elderly suffer strokes. She was still able to work, at an undemanding job, but definitely needed healthcare from a neurologist, in case it happened again. I doubt she expected this at her age, and she probably would have confidently opted out of that type of coverage until it happened to her.
- “Most people don’t expect to suffer from a Mental Illness and probably don’t think that mental health coverage is important, but they don’t think of depression as a ‘mental illness,’ although depression is common after treatment for a serious illness or traumatic injury or in parents of a premature baby. It can easily affect the family relationship, and can also slow recovery from an illness or accident and make it hard or impossible to return to work, especially without treatment.
- “The opiod epidemic has hit WNC, as well as elsewhere, and coverage for Substance Abuse Treatment seems to be the only hope. Most people would probably opt out of that type of coverage, if given the option, but could be easily blind-sided by this problem if they develop back pain, have surgery, or otherwise legitimately encounter this type of medication. The epidemic could become even worse, with no coverage for treatment.
- “A man renewed his ACA insurance, someone who the year before signed up for the first time and had no health problems. He might have opted out of cancer coverage, given his healthy history, but a month later he was diagnosed with an aggressive cancer that had to be treated in Houston, Texas. Luckily, he had bought a broad coverage policy, and his Cancer Treatment was covered.
- “Before the Affordable Care Act, women starting a new job were terrified that they might get pregnant and deliver a premature baby, because the insurance company could claim that the Pregnancy was a ‘pre-existing condition’ and not cover care for the pregnancy and delivery. Without Birth Control coverage, this exact scenario did happen.
- “At a recent gathering, a speaker asked who in the crowd had a ‘Preexisting Condition,’ and fully three-fourths of the people there raised their hands. I met a man in his thirties who told me he had been diagnosed with a urinary tract problem earlier in his life, and had been told, before the ACA, that because of this pre-existing condition he would never be eligible for health insurance! Can you imagine going your entire life without health insurance?
- “Another WNC resident I met was put in the N.C. High Risk Pool because of a preexisting condition for which he needed an expensive medication. He worked for the equivalent of the first two months each year just to pay for his medications before he got insurance through the Affordable Care Act. After the ACA, he was able to start his own business, and maintain his health without being bankrupted by his medication costs.
“REQUESTS:
- “Maintain the 10 Essential Health Benefits, as outlined in the Patient Protection and Affordable Care Act. It is irresponsible to encourage people to play roulette with their healthcare coverage by having them pick and choose their coverage.
- “Require the insurance companies to Cover Everyone with Pre-existing Conditions. Probably by the age of 18, most if not all of your constituents have some condition that could cause them to be refused coverage by insurance companies, if that were allowed.
- “Eliminate the Need for High Risk Pools. They are incredibly expensive for both your constituents and the states who administer them.
- “Keep the Republicans’ promise to Provide Better Coverage to More People, and Lower Premiums.”