Politics Obamacare Protection of Individuals With Pre-Existing Conditions

Politics: Obamacare-Protection of Individuals With Pre-Existing Conditions

The Patient Protection and Affordable Care Act (PPACA) commonly referred to as Obamacare was signed into law on March 23, 2010 by President Barack Obama. The law was instituted to decrease the number of uninsured Americans and reduce the overall cost of health care. This paper seeks to show that PPACA Act, that was intended to decrease the number of uninsured Americans and reduce overall health care costs, actually contains misconceptions that are yet to be resolved almost two years after it was signed into law.

You and I know that under PPACA Act, insurance companies are compelled to cover all applicants regardless of pre-existing conditions or gender with the Congressional Budget Office projecting that the Act stands to lower future deficits and Medicare spending. The "pre-existing conditions" clause is particularly mind boggling. Is this health insurance scheme all inclusive or it tries to block a given percentage of population from enjoying their constitutional rights? Does a cancer survivor stand to gain anything from this health insurance scheme or they can as well be denied health coverage due to their past medical conditions?

A number of provisions outlined in PPACA were supposed to take effect when the federal statute was signed into law in March 2010. A provision like guaranteed issue required that policies be issued regardless of any medical condition. Partial community rating provision on the hand compelled insurance companies to offer same premium to all applicants of the same age and geographical location regardless of their gender or most pre-existing conditions. These provisions locked those who were using tobacco initially. You don't have to be a rocket scientist to know that lung cancer is predominantly caused by smoking tobacco products. That aside, PPACA Act also contains shared responsibility provisions commonly called an individual mandate. This requirement calls upon individuals that are not covered by their employer's sponsored health plan, Medicaid, Medicaid, or other public insurance programs to purchase and comply with an approved private insurance policy or risk penalty. Those exempted here are members of religious sects and those in financial difficulties. Low income individuals and families above 100% and up to 400% of the federal poverty level according to the health insurance scheme qualify to receive federal subsidies on a sliding scale that is if they decide to purchase insurance via an exchange. The law also expands Medicaid eligibility to all individuals and families with income up to 133% of the poverty level. The law also purports to play a role in simplifying the CHIP enrollment process.

Having shed some light on the provisions of the PPACA Act, let's now revisit the issue of "pre-existing conditions" bearing in mind that it was an emotive subject of debate in health care debate in the United States in 2009 and 2010 with majority of people opposing its exclusion by insurance industries and preferring its subsequent ban. Pre-existing condition is a medical condition that occurred before a program of health benefit comes into effect. Based on this definition, it is evident that "pre-existing condition" clause serves no purpose than rationing health care. Regardless of the definition which insurance companies give, "objective standard" or "prudent person," rationing of healthcare is still evident.

Definitions used by insurance companies are dictated by states where these insurance companies operate. Some states compel them to use objective standard definition where as other states require insurance companies to use prudent person standard definition. McCarran-Fergusson Act of 1945 bestows upon individual states within the United States the power to regulate pre-existing condition exclusions in individual and small group health insurance plans. The Act delegated insurance regulation responsibilities to individual states.