Legacy CEO: Health Care After Kennedy
This op-ed originally appeared in the Houston Chronicle on July 11, 2018
By Katy Caldwell
Who would have thought the retirement of a single U.S. Supreme Court justice could effectively decide whether you’re eligible for health insurance if you have a pre-existing medical condition? It sounds a little far-fetched, but it seems to be where we’re headed.
There was a time when insurance companies refused coverage or jacked up the rates for people who had pre-existing conditions such as cancer, diabetes, HIV or Alzheimer’s and even for babies born with a congenital heart disease. That was insanity. Treating sickness — and paying for it — is the very reason why people have insurance in the first place.
Despite its flaws, the Affordable Care Act effectively made insurance companies cover people no matter their medical history. The outcome has been a good one. President Trump’s health department said last year that the ACA is “protecting between 23 and 51 percent of nonelderly Americans — 61 to 133 million people — with some type of pre-existing health condition from being denied coverage…”
Almost two-thirds of voters nationwide support candidates this year who want to keep pre-existing condition coverage, according to a recent non-partisan Kaiser Family Foundation poll. A whopping 75 percent of Texas voters agreed, in a separate poll, with prohibiting insurance companies from denying coverage because of previous medical condition.
For once, we almost all agree on something and something that is a good for people’s health. Why blow that up?
Blow up it could.
Last month the Department of Justice filed a court brief — in a lawsuit brought by the state of Texas — arguing the popular provision in the ACA allowing people with pre-existing conditions to receive insurance coverage was unconstitutional. Since congressional Republicans repealed the mandate that Americans buy insurance or pay a tax penalty, all provisions such as covering pre-existing conditions in the ACA, the thinking goes, are null and void, i.e., unconstitutional.
There is a ways to go in this case. But it’s expected to end up at the Supreme Court. All eyes are now on Judge Brett Kavanaugh, the nominee to replace Justice Anthony Kennedy. Kavanaugh has challenged parts of the ACA in his prior opinions, but the Senate confirmation process must dig into where he stands on the constitutionality of pre-existing conditions and other such provisions.
Here’s why this matters to Texas.
Houston, like other parts of the state, has the best medical treatment and research institutions in the country. Yet we have monster health challenges, such as obesity, opioid use, HIV and acute mental health conditions. The flu and flu-related pneumonia led to 9,400 Texas deaths in 2017-18. Maternal mortality, especially among African-Americans, is frighteningly high. We have the highest number of uninsured patients of all 50 states.
So taking away coverage for pre-existing medical conditions would add fuel to an already burning fire here. A Kaiser study estimated 4.5 million Texans had pre-existing health conditions that would likely make them uninsurable if this provision of the ACA goes away.
If I had my druthers, Texas would be fixing our own health care system in our own way — not kowtowing to the instability of D.C. and unpredictable political winds. I get that many Texas Republicans loathe Obamacare. And that Medicaid expansion isn’t politically viable, even though it would cover millions of Texans with money we have already paid in federal taxes. If not any of this, then what?
Maybe our lawmakers could take a look at protecting pre-existing conditions in state law. Patients who are trying to get insurance to treat, or prevent, chronic physical and mental health conditions are, in my book, showing personal responsibility. Without it, they’ll just get sicker and go to the costly emergency room. I think we all agree that needs to stop unless there’s a real emergency.
Call me old-fashioned, but government, whether big or small, is supposed to help fix problems, not fight about them endlessly. For us, it’s all about serving our patients and communities. On our intake form, we don’t have patients check a “Republican” or “Democrat” box.
The good news? There’s a big election in the fall. Go vote for the candidates in both parties who want to do the right thing for the health of all Texans.
Caldwell is CEO of Legacy Community Health, Houston.